背景:已在患有心血管疾病(如动脉高血压)的患者中发现了视网膜微血管异常,糖尿病,和颈动脉疾病.我们进行了系统评价和荟萃分析(PROSPERO注册号CRD42024506589),以通过光学相干断层扫描(OCT)和光学相干断层扫描血管造影(OCTA)探讨视网膜血管作为诊断和监测冠状动脉疾病(CAD)患者的生物标志物的潜力。
方法:我们系统地检查了Pubmed,Embase,和WebofScience数据库从成立到2023年11月,比较了CAD患者和对照组之间的视网膜微血管特征。如果他们报告了具有标准偏差的样品平均值或具有范围和/或四分位间范围的中值(其计算为平均值和标准偏差),则包括研究。审查经理5.4(Cochrane协作,2020)采用随机-效应逆方差法,采用加权均差和95%置信区间(CI)计算合并效应大小。
结果:11项符合纳入标准的研究纳入荟萃分析。结果表明视网膜神经纤维层明显减少(WMD-3.11[-6.06,-0.16]),中央凹下脉络膜(WMD-58.79[-64.65,-52.93]),与对照组相比,CAD患者的总体视网膜厚度(WMD-4.61[-7.05,-2.17])(p<0.05)。此外,冠心病患者的血管黄斑密度明显较低,特别是在浅表毛细血管丛(中央凹血管密度WMD-2.19[-3.02,-1.135],p<0.0001)。此外,与对照组相比,CAD患者的中央凹无血管区面积在统计学上较大(WMD52.73[8.79,96.67],p=0.02)。除中央凹下脉络膜厚度外,大多数特征的异质性是显着的(I2>50%),视网膜厚度,浅凹血管密度。
结论:当前的荟萃分析表明,视网膜血管形成可以作为一种非侵入性生物标志物,为评估冠状动脉功能障碍提供标准常规检查以外的其他见解。
BACKGROUND: Retinal microvascular anomalies have been identified in patients with cardiovascular conditions such as arterial hypertension, diabetes mellitus, and carotid artery disease. We conducted a systematic
review and meta-analysis (PROSPERO registration number CRD42024506589) to explore the potential of
retinal vasculature as a biomarker for diagnosis and monitoring of patients with coronary artery disease (CAD) through optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).
METHODS: We systematically examined original articles in the Pubmed, Embase, and Web of Science databases from their inception up to November 2023, comparing retinal microvascular features between patients with CAD and control groups. Studies were included if they reported sample mean with standard deviation or median with range and/or interquartile range (which were computed into mean and standard deviation).
Review Manager 5.4 (The Cochrane Collaboration, 2020) software was used to calculate the pooled effect size with weighted mean difference and 95% confidence intervals (CI) by random-effects inverse variance method.
RESULTS: Eleven studies meeting the inclusion criteria were incorporated into the meta-analysis. The findings indicated a significant decrease in the retinal nerve fiber layer (WMD -3.11 [-6.06, -0.16]), subfoveal choroid (WMD -58.79 [-64.65, -52.93]), and overall
retinal thickness (WMD -4.61 [-7.05, -2.17]) among patients with CAD compared to controls (p < 0.05). Furthermore, vascular macular density was notably lower in CAD patients, particularly in the superficial capillary plexus (foveal vessel density WMD -2.19 [-3.02, -1.135], p < 0.0001). Additionally, the foveal avascular zone area was statistically larger in CAD patients compared to the control group (WMD 52.73 [8.79, 96.67], p = 0.02). Heterogeneity was significant (I2 > 50%) for most features except for subfoveal choroid thickness, retina thickness, and superficial foveal vessel density.
CONCLUSIONS: The current meta-analysis suggests that retinal vascularization could function as a noninvasive biomarker, providing additional insights beyond standard routine examinations for assessing dysfunction in coronary arteries.