Hypertrophic remodelling of retinal arterioles in patients with congestive heart failure

Aims Analysis of microvascular parameters in the retinal circulation-known to reflect those in the systemic circulation-allows us to differentiate between eutrophic and hypertrophic remodelling of small arteries. This study aimed to examine microvascular changes in patients with congestive heart failure (CHF) and reduced as well as mid-range ejection fraction. Methods and results Forty subjects with CHF underwent measurement of retinal capillary flow (RCF), wall-to-lumen ratio (WLR), vessel and lumen diameter, wall thickness, and wall cross-sectional area (WCSA) of retinal arterioles of the right eye by scanning laser Doppler flowmetry (SLDF). Applying a matched pair approach, we compared this group with reference values of age-matched controls from a random sample in the population of Pilsen, Czech Republic. There was no significant difference in RCF and WLR between the groups (RCF: P = 0.513; WLR: P = 0.106). In contrast, wall thickness and WCSA, indicators of hypertrophic remodelling, were higher in CHF subjects (WT: 15.0 +/- 4.2 vs. 12.7 +/- 4.2 mu m, P = 0.021; WCSA: 4437.6 +/- 1314.5 vs. 3615.9 +/- 1567.8 mu m(2), P = 0.014). Similarly, vessel (109.4 +/- 11.1 vs. 100.5 +/- 14.4 mu m, P = 0.002) and lumen diameter (79.0 +/- 7.9 vs. 75.2 +/- 8.5 mu m, P = 0.009) were increased in CHF. Conclusions In CHF subjects, we observed hypertrophic remodelling of retinal arterioles indicative of similar changes of small resistance arteries in the systemic circulation. Microvascular structure and function assessed by SLDF may thereby represent a useful, non-invasive method for monitoring of microvascular damage in patients with CHF and may offer innovative treatment targets for new CHF therapies.

Automated summary

Analysis of microvascular parameters in patients with congestive heart failure (CHF) revealed hypertrophic remodeling of retinal arterioles, with increased wall thickness, wall cross-sectional area, vessel and lumen diameter compared to age-matched controls. This suggests that microvascular structure and function assessed through scanning laser Doppler flowmetry (SLDF) may be a useful non-invasive method for monitoring microvascular damage in CHF patients and identifying potential new treatment targets for CHF therapies.