The Evaluation of the Relationship of Microvascular Changes in the Retina, Choroid with Acute Coronary Syndromes and Their Risk Factors

The aim: To evaluate the relationship of acute coronary syndromes and their risk factros with microvascular changes in the retina and choroid. The objectives: 1) to compare cardiovascular disease (CVD) risk factors between the study and control groups; 2) to determinte association of changes in retina, choroid with the development of acute coronary syndroms (ACS) – myocardial infarction without and with ST segments elevation (NSTEMI and STEMI); 3) to evaluate microvascular changes in the retina, choroid in patients without coronary artery stenosis by angiographic examination. Methods: the study included 47 patients with ACS (NSTEMI, STEMI) and 47 healthy patients. Coronary artery angiography and ocular optical coherence tomography-angiography were performed for all patients. Data of risk factors of CVS, laboratory and echocardiography results were collected from case history and examination. Results: According to the research groups – ACS was more common in men (74,5% vs. 51,1%, p=0.019). Patients in the ACS group had a higher alcohol consumption (74,5% vs. 51,1%, p=0.019), active smoking (53,2% vs. 17%, p=0.001), inflammatory markers: leukocytosis, CRP (9.56±11.49 vs. 2.52±2.30, p=0.005), neutrophil/lymphocyte ratio (3.09±1.96 vs. 1.53±0.59, p=0.001), worse markers of renal function and lower LV ejection fraction compared to control group. The vasculars density of temporal (right and left eye, respectively, p=0.045 ir p=0.001) and lower (right and left eye, respectively, p=0,008 ir p=0,002) parts of the superficial capillary plexus (SCP) was lower in ACS group than control group. The density of the deep capillary plexus (DCP) in the nasal area (right and left eye, respectively, p=0.003 ir p=0.002), in the temporal area of the right eye (p=0.020) and in the upper part of left eye (p=0.019) was lower in the ACS group. STEMI has a 8-fold higher chance of having lower inner vascular density compared to NSTEMI (p=0.005). Patients of ACS group with increased left ventricular (LV) relative wall thickness (RWT) was 6-fold more likely to have a lower inner vascular density compared with normal RWT (p=0.023). Control subjects with decreased high-density lipoprotein cholesterol (HDL-CH) were 4.5-fold more likely to have lower inner vascular density (p=0.027). Conclusion: Active smoking, duration of smoking, increased alcohol consumption and male gender are associated with the developments of myocardial infarction. Microvascular retinal dysfunction is associated with ACS and structural changes in the LV: lower retinal inner vascular density increases the possibility of STEMI 8-fold and possibility of higher left ventricular RWT 6-fold