Search Results (13)

Cardiovascular adaptation is vital for a healthy pregnancy but may be impaired in women at high risk for preeclampsia (PE), a condition marked by endothelial dysfunction. Smoking may lower the PE risk but harms vessels, and the effects of early cessation remain unclear. This prospective cohort study assessed vascular changes in high-risk pregnancies and the potential influence of early smoking cessation. Of 110 women screened for PE in the first trimester, 43 were classified as high-risk: 18 former smokers and 25 lifelong non-smokers. Vascular assessments were performed at 11–16, 24–28, and 34–37 weeks of gestation. Parameters included the carotid–femoral pulse wave velocity (cfPWV), asymmetric dimethylarginine (ADMA), mean arterial pressure (MAP), systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and retinal vessel calibers (central retinal arteriolar and venular equivalents (CRAE, CRVE)). Serum cotinine confirmed abstinence in former smokers. Across gestation, ADMA (p = 0.034), MAP (p = 0.001), SBP (p = 0.033), DBP (p = 0.004), and HR (p = 0.004) increased, while CRAE (p = 0.016) and CRVE (p = 0.004) narrowed in late pregnancy; cfPWV remained stable (p = 0.783). Non-smokers showed increases in their ADMA (p = 0.020), MAP (p = 0.001), and DBP (p = 0.0001) with no differences between groups. High-risk pregnancies showed vascular changes with similar profiles in former and non-smokers, underscoring the need for broader studies. Full article

Background: The aim of this study was to assess the agreement between different analysis protocols for the determination of retinal vessel dilation response to flicker light (FL) and its relation to static and metabolic parameters of retinal vessels in healthy subjects. Methods: In total, 24 right eyes of 24 healthy controls (mean age: 36.04 ± SD 14.4 years) who underwent dynamic and static retinal diameter and oxygen saturation measurements on a Retinal Vessel Analyzer (RVA, Imedos, Jena, Germany) were included. Using repeated video analyses, responses to FL were measured with RVA. These measurements were conducted at three specific retinal locations: within the superotemporal area—within a distance of less than one optic disk (OD) diameter to optic nerve head (ONH) (group 1); greater than one OD diameter to ONH (group 2); and areas near the ONH within the VesselMap region (group 3). For comparability, the static and oxygen saturation parameters were also calculated in the superotemporal peripapillary area using the VesselMap tool of the RVA and were evaluated in relation to the corresponding dynamic area (group 3). Results: In all groups, the vascular FL response of arteries was less pronounced compared to venules (p = 0.0014). Even though FL responses (mean ± SD: FL-A; FL-V) in group 1 were more pronounced (3.36 ± 2.31; 4.42 ± 1.69) compared to those in group 2 (2.97 ± 2.40; 4.08 ± 1.55) and group 3 (2.84 ± 2.29; 4.21 ± 2.03), they did not reach statistically significant values. The mean flicker response of venules (VDil) in all groups showed negative correlations to the corresponding static parameter: central retinal venous equivalent (CRV) (r = −0.0437; p = 0.015). The mean flicker response of arteries (ADil) in all groups showed negative correlations to the corresponding metabolic parameter: arterio-venous oxygen extraction fraction (r = −0.101; p = 0.041). Conclusions: Our study confirms that the flicker light response, despite slight variations in its duration and location, allows for reliable measurements, proving the Retinal Vessel Analyzer to be a valuable diagnostic tool. Furthermore, we were able to highlight the relationship between the dynamic and metabolic components of retinal supply, which enables early diagnosis concerning the development of diseases within this spectrum. Full article

Background and Objectives: Screening, primary prevention, and the early identification of high-risk individuals are crucial for minimising the burden of cardiovascular diseases (CVDs). In this study, we aimed to evaluate the association of retinal microvascular features with myocardial dysfunction and CVD risk factors in a group of patients with significant coronary artery disease (CAD) compared to patients with newly diagnosed isolated arterial hypertension and healthy controls. Materials and Methods: We performed a single-centre cross-sectional study on 214 individuals divided into three groups: a group of 99 cases diagnosed with significant CAD, a group of 61 cases with newly diagnosed isolated arterial hypertension, and a control group of 54 cases with no confirmed cardiovascular pathology. Colour optic disc-centred retinal photographs were taken in all cases, and the following parameters were quantified using MONA REVA 3.0.0 software (VITO Health, Mol, Belgium): central retinal arteriolar equivalent, central retinal venular equivalent, arteriovenous ratio, fractal dimension, tortuosity index, and lacunarity. Univariable and multivariable statistical analyses were performed to assess changes in retinal microvascular features in CVD. Results: Dyslipidaemia (p = 0.009), systolic blood pressure (p = 0.008), and LDL cholesterol (p = 0.003) were negatively associated while left ventricular (LV) strain (0.043) was positively associated with the CRAE. In the case of the CRVE, the coronary Agatston score (p = 0.016) proved a positive and HDL cholesterol (p = 0.018) a negative association. A lower fractal dimension was associated with the presence of diabetes mellitus (p = 0.006), dyslipidaemia (p = 0.011), and a history of acute myocardial infarction (p = 0.018), while a higher fractal dimension was associated with increased left ventricular ejection fraction (LVEF) (p = 0.006) and medical treatment (p = 0.005). Lacunarity was higher in patients of female gender (p = 0.005), with decreased HDL (p = 0.014) and LVEF (0.005), and with increased age (p < 0.001) and Agatston score (p = 0.001). The vessel tortuosity index increased with LV strain (p = 0.05), medical treatment (p = 0.043), and male gender (p = 0.006). Conclusions: Retinal microvascular features may serve as additional risk stratification tools in patients with CVD, particularly CAD, pending prospective validation. Full article

Background/Objectives: Cardiovascular diseases are a leading cause of death, and psychosocial stress is considered a contributing factor to these issues. With the rising number of heart surgeries, proper rehabilitation post-surgery is essential. Previous studies have demonstrated the positive impact of yoga and transcendental meditation on the cardiovascular system. This pilot study aimed to investigate the effects of yoga and transcendental meditation on retinal microcirculation in cardiac patients before (admission), after (discharge), and following (3 weeks after discharge) rehabilitation. Methods: This study examined changes in retinal microcirculation in three rehabilitation groups of patients after heart surgery. The control group received standard exercise therapy, while the meditation group incorporated 20 min of meditation, and the yoga group incorporated 20 min of yoga practice, twice per day for the duration of four weeks of rehabilitation. Retinal images were captured using a non-mydriatic digital retinal camera (Canon CR-2, Canon Medical Systems Europe B.V., Netherlands), and the microcirculation parameters central retinal artery equivalent, central retinal vein equivalent, and artery-to-vein ratio were analyzed using MONA REVA software ((version 2.1.1), VITO, Mol, Belgium). Repeated measures ANOVA was performed to evaluate differences between the three groups in the course of rehabilitation. Results: None of the parameters revealed significant differences in retinal microcirculation between the three rehabilitation groups. Conclusions: The study evaluating changes in retinal microcirculation, as an indicator of central circulation in cardiac patients undergoing rehabilitation, did not observe any significant changes. As yoga and meditation are underestimated approaches in cardiac rehabilitation, this pilot study acts as a basis for providing preliminary information for future studies to encourage the research community to fill the gap in this area. Full article

Background/Objectives: Inadequate cardiovascular adaptation during pregnancy impairs endothelial function and vascular resistance, contributing to complications such as pre-eclampsia (PE) and gestational hypertension (GH). Neprilysin (NEP), a protease involved in vascular regulation, has been linked to PE, but its role in endothelial function and vascular adaptation remains unclear. This pilot study investigates the associations between soluble neprilysin (sNEP) and markers of vascular and renal function in high-risk pregnancies without PE. Methods: Observed parameters were analyzed in 29 high-risk pregnant women across early, mid-, and late pregnancy. sNEP levels were analyzed alongside body mass index (BMI), endothelial dysfunction (ADMA), arterial stiffness (pulse wave velocity, PWV), retinal microvasculature (central retinal arteriolar and venular equivalents, CRAE and CRVE), and kidney function markers. The impact of gestational hypertension (GH) and prior smoking on sNEP levels was also evaluated. Results: In early and mid-pregnancy, sNEP was inversely associated with BMI. During mid-pregnancy, sNEP showed a positive correlation with CRAE and an inverse correlation with PWV, suggesting reduced arterial stiffness. By late pregnancy, sNEP was positively associated with glomerular filtration rate and inversely correlated with creatinine and protein levels, reflecting improved kidney function. Women with GH exhibited elevated sNEP, while former smokers had lower sNEP levels in early pregnancy. Conclusions: These findings suggest that sNEP plays a role in vascular and renal adaption during pregnancy, offering new perspectives on vascular tone regulation in high-risk pregnancies. Further research is needed to clarify these mechanisms and their clinical relevance. Full article

Background/Objectives: Acute retinal ischemia, including central retinal artery occlusion (CRAO), is recognized as a stroke equivalent by the American Heart Association/American Stroke Association (AHA/ASA), necessitating immediate multidisciplinary evaluation and management. However, referral patterns among ophthalmologists remain inconsistent, and evidence-based therapeutic interventions to improve visual outcomes are currently lacking. CRAO is associated with a significantly elevated risk of subsequent acute ischemic stroke (AIS), particularly within the first week following diagnosis, yet the role of intravenous thrombolysis (IVT) in this setting remains controversial. This case report presents a unique case of CRAO with concurrent internal carotid artery (ICA) occlusion, followed by an AIS affecting the middle cerebral artery (MCA). Case presentation: An 83-year-old woman presented with acute, painless monocular vision loss to the emergency department. IVT was administered within 4.5 h of admission for suspected CRAO associated with ICA occlusion (ICAO) identified on CT-angiography (CTA). One hour post-thrombolysis, CT-perfusion (CTP) confirmed MCA occlusion (MCAO), necessitating mechanical thrombectomy (MT). Successful recanalization was achieved without complications, and the patient demonstrated no functional impairments at discharge. Conclusions: This case underscores the importance of maintaining a vigilant approach to stroke management in CRAO patients. It highlights the diagnostic challenges encountered in clinical practice and advocates for further research into the role of IVT in CRAO cases with ICAO, emphasizing the need for consensus in treatment. Full article

Nutrition is critical during pregnancy for the healthy growth of the developing infant, who is fully dependent on maternal dietary omega-3 supply for development. Fatty fish, a main dietary source of omega-3, is associated with decreased cardiovascular risk in adults. We conducted a longitudinal study based on a mother–offspring cohort as part of the project Infancia y Medio Ambiente (INMA) in order to assess whether fish intake during pregnancy relates to cardiovascular health in children. A total of 657 women were included and followed throughout pregnancy until birth, and their children were enrolled at birth and followed up until age 11–12. A semi-quantitative food frequency questionnaire was used to assess the daily intake of foods during the 1st and 3rd trimesters of pregnancy. Cardiovascular assessments included arterial stiffness (assessed by carotid–femoral pulse wave velocity [PWV]) and retinal microcirculation (photographic assessment of central retinal arteriolar and venular equivalent [CRAE and CRVE]). The association between maternal fish consumption and cardiovascular outcomes of offspring at 11 years of age was evaluated using multivariable linear regression models. There were no statistically significant differences in any cardiovascular endpoint in children whose mothers had a higher fish consumption during pregnancy compared to those with a lower fish consumption. We found a slightly higher PWV (β = 0.1, 95% CI = 0.0; 0.2, p for trend = 0.047) in children whose mothers had a higher consumption of canned tuna during the 1st trimester of pregnancy. Fish intake during pregnancy was found to be unrelated to the offspring’s cardiovascular health at 11 years of age. The beneficial cardiovascular effects of fish consumption during pregnancy on the offspring are still inconclusive. Full article

Purpose: This study aims to assess the effect of bariatric surgery on retinal microvascular calibre, peripheral microvascular function, peripheral pressure waveforms, and the general cardiovascular disease (CVD) risk in obese individuals after undergoing Roux-en-Y gastric bypass (RYGB) surgery. Methods: A total of 29 obese participants were included in the study. All of the measurements were conducted at two time points: before and one year following the bariatric surgery procedure. General anthropometric data, as well as blood markers for glucose, cholesterol, and triglycerides were assessed in all individuals. In all participants, the Framingham risk score (FRS), and retinal vessel calibre measurements, using a Zeiss fundus camera and VesselMap software (ImedosSystems, Jena, Germany), were performed. Systemic arterial stiffness was measured by pulse wave analysis (PWA), and peripheral microvascular reactivity by way of digital thermal monitoring (DTM) in all participants. Results: As expected, various general anthropometric parameters, including body mass index (BMI), waist circumference and neck circumference, were significantly decreased post-surgery comparing to baseline in all individuals (all p < 0.001). In addition, their general CVD risk, as measured using FRS, was significantly improved (p < 0.001). At the retinal vascular level, central retinal artery equivalent (CRAE) as well as, central retinal vein equivalent (CRVE) had increased after surgery comparing to the baseline values (p = 0.003 and p = 0.007, respectively). In addition, both systemic arterial stiffness and peripheral microvascular reactivity had improved in all participants (p < 0.001 and p = 0.008 respectively). Conclusions: Our findings suggest that bariatric surgery has a positive effect on the overall vascular health, as well as on the general CVD risk of the obese patients undergoing this procedure. Full article

The appropriate surgical technique to improve the closure rate of perioperative full-thickness macular hole (FTMH) secondary to submacular hemorrhage (SMH) with sub-internal limiting membrane (ILM) hemorrhage caused by retinal arterial macroaneurysm (RAM) rupture remains an unsolved clinical problem. Several ILM transplantation techniques have been attempted, but these are challenging. Our new technique can remove sub-ILM hemorrhage with the central fovea ILM intact, without peeling the ILM. The medical records of three eyes from three patients with SMH and sub-ILM hemorrhage secondary to RAM rupture were retrospectively reviewed. During the surgery, a small ILM fissure was made outside the central fovea with ILM forceps, and sub-ILM hemorrhage was washed out through it by manually spraying balanced salt solution. Sub-ILM hemorrhage removal was achieved successfully in all eyes, with no occurrences of FTMH or other complications. Best-corrected decimal visual acuity improved from 0.05 (Snellen equivalent (SE), 20/400), 0.05 (SE, 20/400), and 0.05 (SE, 20/400) preoperatively to 0.3 (SE, 20/63), 0.4 (SE, 20/50), and 0.15 (SE, 20/125) at 3 months postoperatively, respectively. This new technique may help keep the foveal ILM intact and prevent perioperative FTMH formation. Full article

(1) Background: Studies have reported the effectiveness of light therapy in various medical conditions. Our pilot study aimed to assess the effect of Maharishi light therapy (MLT) on physiological parameters, such as the heart rate (HR), HR variability (HRV), blood pressure (BP), BP variability (BPV), and the retinal microvasculature of healthy participants; (2) Methodology: Thirty (14 males and 16 females) healthy, non-smoking participants between 23 and 71 years old (46 ± 18 years) were included in this randomized crossover study. Each participant was tested with a placebo (using LED light) and gem lights, 24 h apart. Hemodynamic parameters were recorded during the session, and 24 h heart rate and BP levels were assessed via mobile devices. Retinal vascular responses were captured with fundus images and the subsequent analysis of retinal vessel widths. A linear model, using repeated measures ANOVA, was used to compare the responses across the sexes and to assess the effect of the MLT; (3) Results: Changes in the central retinal artery equivalent (CRAE) (p < 0.001) and central retinal vein equivalent (CRVE) (p = 0.002) parameters were observed. CRAE and CRVE decreased under MLT and increased under the placebo condition from before to after. However, the baseline values of the participants already differed significantly before the application of any therapy, and the variation in the retinal vessel diameters was already large in the baseline measurements. This suggests that the observed effect results may only reflect naturally occurring fluctuations in the microcirculation and not the effect of MLT. Furthermore, no significant effects were observed in any other investigated parameters; (4) Conclusion: Our study with healthy participants finds significant changes in retinal parameters, but the biological variation in the baseline measurements was large to begin with. This suggests that the observed effect results only reflect naturally occurring fluctuations in the microcirculation and not the effect of MLT. However, in the future, larger studies in which MLT is applied for longer periods and/or in patients with different diseases could discover the physiological impacts of this type of therapy. Full article

We aimed to compare measurements from three of the most widely used software packages in the literature and to generate conversion algorithms for measurement of the central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) between SIVA and IVAN and between SIVA and VAMPIRE. We analyzed 223 retinal photographs from 133 human participants using both SIVA, VAMPIRE and IVAN independently for computing CRAE and CRVE. Agreement between measurements was assessed using Bland–Altman plots and intra-class correlation coefficients. A conversion algorithm between measurements was carried out using linear regression, and validated using bootstrapping and root-mean-square error. The agreement between VAMPIRE and IVAN was poor to moderate: The mean difference was 20.2 µm (95% limits of agreement, LOA, −12.2–52.6 µm) for CRAE and 21.0 µm (95% LOA, −17.5–59.5 µm) for CRVE. The agreement between VAMPIRE and SIVA was also poor to moderate: the mean difference was 36.6 µm (95% LOA, −12.8–60.4 µm) for CRAE, and 40.3 µm (95% LOA, 5.6–75.0 µm) for CRVE. The agreement between IVAN and SIVA was good to excellent: the mean difference was 16.4 µm (95% LOA, −4.25–37.0 µm) for CRAE, and 19.3 µm (95% LOA, 0.09–38.6 µm) for CRVE. We propose an algorithm converting IVAN and VAMPIRE measurements into SIVA-estimated measurements, which could be used to homogenize sets of vessel measurements obtained with different software packages. Full article

The retinal vessel narrowing may be implicated in the pathogenesis of glaucoma; however, the association between systemic oxidative stress and retinal vessel diameter remains largely unknown. We examined the relationship between serum oxidative stress markers and retinal vessel diameters in eyes with primary open-angle glaucoma (POAG) and cataract, using central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE). We included 66 eyes of 66 patients with POAG (37 men, 29 women; 65.4 ± 11.7 years) and 20 eyes of 20 patients with cataract (7 men, 13 women; 69.4 ± 9.0 years) as the controls. The CRAE (p < 0.0001), CRVE (p < 0.0001), and serum biological antioxidant potential (BAP) (p = 0.0419) were significantly lower in the POAG group compared to the controls. The BAP showed significant correlation both with CRAE (ρ = 0.2148, p = 0.0471) and systolic blood pressure (ρ = −0.2431, p = 0.0241), while neither Diacron reactive oxygen metabolites nor sulfhydryl test correlated with them. The multivariate analyses indicated that age, best corrected visual acuity, and BAP were independent factors for CRAE or CRVE. The present study suggested that lower systemic antioxidant capacity was significantly associated with the intraocular pressure-independent vascular narrowing in POAG patients. This study provided a novel insight into the pathophysiology of glaucoma and highlighted the clinical impact on systemic antioxidant treatment for patients with glaucoma. Full article

Exposure to ambient NO₂ and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO₂ and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO₂ was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region. Full article