Results of optical coherence tomography angiography of the central retinal zone in patients with chronic heart failure with preserved ejection fraction

Purpose of the study: to evaluate and compare morphometric parameters (biomarkers) of the retina and choroid obtained using optical coherence tomography angiography (OCTA) in patients with chronic heart failure with preserved ejection fraction (HFpEF).

Material and methods. The study included 32 patients (61 eyes) with a verified diagnosis of HFpEF and 30 healthy individuals (62 eyes) in the control group, matched for age and sex. Patients in the study group were divided into three subgroups according to the functional class (FC) based on the New York Heart Association (NYHA) classification: FC I — 10 patients (20 eyes), FC II — 13 patients (23 eyes), FC III — 9 patients (18 eyes). All participants underwent OCTA using a DRI OCT-Triton device (Topcon, Japan). The assessed parameters included foveal avascular zone (FAZ) area, vessel density (vd) in the superficial (SCP) and deep (DCP) capillary plexuses, in the choriocapillaris (CC) layer, and in the choroid (C).

Results. Patients with HFpEF demonstrated a statistically significant reduction in mean vessel density in the DCP (mean vd DCP, p = 0.009), in the CC (p = 0.004), as well as in the inferior (p = 0.019) and temporal (p = 0.012) sectors of the choroid compared to the control group. Topical specificity of the damage was observed: the most pronounced changes in the CC were recorded in the inferior sector of the paramacular zone (p = 0.004). Intragroup analysis revealed a progressive decrease in mean vd CC with increasing NYHA FC. Correlation analysis showed a moderate negative relationship between NYHA FC and CC vessel density (ρ = –0.335, p = 0.018), as well as between NYHA FC and choroidal vessel density in the superior sector (ρ = –0.345, p = 0.015).

Conclusion. HFpEF is associated with multi-level microcirculatory changes in the retina and choroid, which are sectorally heterogeneous. OCTA biomarkers, such as mean vessel density of the DCP and mean vessel density of the choriocapillaris layer, may be recommended as an early and non-invasive monitoring tools for systemic microcirculatory dysfunction in patients with HFpEF.

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