Retinal Vascular Parameters and Risk of Heart Failure

AimTo investigate the association of retinal vascular parameters (calibre, tortuosity, fractal dimension and the number of segments) with incident heart failure (HF) in the UK Biobank. MethodsParticipants with fundus images in UK Biobank were included. Retinal vascular parameters were assessed by an artificial intelligence system (RMHAS). Incident HF events were determined by hospital inpatient data, death register records and self-reported medical condition. Cox proportional hazards regression models (CPH) were used to investigate the links between retinal vascular variables and the risk of HF. ResultsWe included 56470 individuals. After a median of 10.95-year follow-up, 1062 incident HF events were reported. After adjusting for conventional HF risk factors in CPH, we found larger retinal venular calibre (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.12-2.14), smaller arteriolar fractal dimension (HR, 1.98; 95% CI, 1.38-2.85), smaller venular fractal dimension (HR, 1.52; 95% CI, 1.09-2.13), the smaller number of arteriolar segments (HR, 2.18; 95% CI, 1.47-3.24) and the smaller number of venular segments (HR, 1.85; 95% CI, 1.29-2.64) were linked to an increased risk of HF. The addition of retinal vessel measurements to traditional HF risk factors increased the discrimination capability for predicting future HF, with C statistics changing from 0.799 to 0.813. ConclusionsWider retinal venular calibre, lower vascular fractal dimension and a smaller number of vessel segments were associated with a higher risk of incident HF events. These results point to the potential application of using early retinal vasculature changes to identify people at higher risk of HF.