BACKGROUND Continuous-flow left ventricular assist device (cfLVAD) use is effective in supporting patients with end-stage heart failure (ESHF). Reduced flow pulsatility within the systemic circulation in cfLVAD-supported patients may lead to alterations within the microcirculation. Temporal changes in microvasculature in relation to adverse events in cfLVAD-supported patients have not been studied. We aimed to profile changes within retinal microvasculature and its association with adverse events. METHODS Retinal photography was performed using Topcon TRC-NW8 nonmydriatic fundus camera in cfLVAD-supported patients and ESHF control patients. Specific retinal measurements were evaluated using a validated semiautomated program. Demographic and adverse event data were documented. RESULTS Forty-eight patients were studied (n = 29 cfLVAD, n = 19 ESHF). There were significant trends in retinal arteriolar caliber (B = -0.53 µm, 95% confidence interval [CI]: -0.96 to -0.10, p = 0.016) and retinal fractal dimension parameters (B = 0.014, 95% CI: 0.001-0.002, p = 0.016) in linear mixed model regressions. Among cfLVAD patients, there was a significant association between the incidence of gastrointestinal bleeding and stepwise increases in retinal arteriolar-venular caliber ratio (hazard ratio: 3.03, 95% CI: 2.06-4.45, p = 0.005), a measure of arteriolar narrowing. CONCLUSIONS We have observed for the first time that alterations in retinal microvasculature in cfLVAD-supported patients may be associated with gastrointestinal bleeding. While understanding these temporal changes may predict future adverse events in cfLVAD-supported patients, further multicenter studies are required to confirm the associations observed.

中文翻译：

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视网膜微血管重塑与连续血流左心室辅助装置支持的患者的不良事件相关。


背景 连续流动左心室辅助装置 （cfLVAD） 的使用可有效支持终末期心力衰竭 （ESHF） 患者。在 cfLVAD 支持的患者体内循环内血流搏动减少可能导致微循环发生变化。尚未研究与 cfLVAD 支持患者不良事件相关的微血管系统时间变化。我们旨在分析视网膜微血管系统内的变化及其与不良事件的相关性。方法 使用 Topcon TRC-NW8 非散瞳眼底相机对 cfLVAD 支持患者和 ESHF 对照患者进行视网膜摄影。使用经过验证的半自动程序评估特定的视网膜测量值。记录了人口统计学和不良事件数据。结果 研究了 48 例患者 （n = 29 cfLVAD，n = 19 ESHF）。视网膜小动脉口径 （B = -0.53 μm，95% 置信区间 [CI]： -0.96 至 -0.10，p = 0.016） 和视网膜分形维度参数 （B = 0.014,95% CI： 0.001-0.002，p = 0.016） 在线性混合模型回归中存在显着趋势。在 cfLVAD 患者中，胃肠道出血的发生率与视网膜动脉-静脉口径比的逐步增加之间存在显著关联 （风险比： 3.03,95% CI： 2.06-4.45，p = 0.005），这是小动脉狭窄的衡量标准。结论 我们首次观察到 cfLVAD 支持患者视网膜微血管系统的改变可能与胃肠道出血有关。虽然了解这些时间变化可以预测 cfLVAD 支持患者的未来不良事件，但需要进一步的多中心研究来确认观察到的关联。