Retinal Vessel Analysis as a Novel Screening Tool to Identify Childhood Acute Lymphoblastic Leukemia Survivors at Risk of Cardiovascular Disease.

Autor:	Azanan MS; Departments of Pediatrics.; Pediatric Oncology Research Laboratory, Faculty of Medicine., Chandrasekaran S; Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya., Rosli ES; Pediatric Oncology Research Laboratory, Faculty of Medicine., Chua LL; Pediatric Oncology Research Laboratory, Faculty of Medicine., Oh L; Departments of Pediatrics.; Pediatric Oncology Research Laboratory, Faculty of Medicine., Chin TF; Pediatric Oncology Research Laboratory, Faculty of Medicine., Yap TY; Departments of Pediatrics.; Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, University of Malaya Medical Centre, Kuala Lumpur, Malaysia., Rajagopal R; Departments of Pediatrics.; Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, University of Malaya Medical Centre, Kuala Lumpur, Malaysia., Rajasuriar R; Medicine., MacGillivray T; VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh., Trucco E; VAMPIRE Project, Computing (SSEN), University of Dundee, Dundee, United Kingdom., Ramli N; Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya., Kamalden TA; Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya., Ariffin H; Departments of Pediatrics.; Pediatric Oncology Research Laboratory, Faculty of Medicine.; Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Jazyk:	angličtina
Zdroj:	Journal of pediatric hematology/oncology [J Pediatr Hematol Oncol] 2020 Aug; Vol. 42 (6), pp. e394-e400.
DOI:	10.1097/MPH.0000000000001766
Abstrakt:	Background: Microvascular endothelial dysfunction is central to the pathogenesis of cardiovascular disease (CVD). The eye offers direct access for endothelial health assessment via the retinal microvasculature. The aim of the study was to investigate whether image-based retinal vessel analysis is a feasible method of assessing endothelial health in survivors of childhood acute lymphoblastic leukemia (cALL). Materials and Methods: Cardiovascular risk factors (CRFs) were estimated using the 30-year Framingham Risk Score in 73 childhood leukemia survivors (median age: 25; median years from diagnosis: 19) and 78 healthy controls (median age: 23). Radial arterial stiffness was measured using pulse wave analyzer, while endothelial activation markers were measured by soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1). Retinal fundus images were analyzed for central retinal artery/vein equivalents (CRAE/CRVE) and arteriolar-venular ratio (AVR). Results: cALL survivors had higher CRF (P<0.0001), arterial stiffness (P=0.001), and sVCAM-1 (P=0.007) compared with controls. Survivors also had significantly higher CRVE (P=0.021) while AVR was significantly lower (P=0.026) in survivors compared with controls, compatible with endothelial dysfunction. In cALL survivors with intermediate risk for CVD, CRAE, and AVR are significantly lower, while sVCAM-1 and sICAM-1 are significantly higher when compared with survivors with low CVD risk after adjusting with covariates (age, sex, and smoking status). Conclusions: cALL survivors have an increased risk of CVD compared with age-matched peers. The survivors demonstrated microvasculopathy, as measured by retinal vascular analysis, in addition to physical and biochemical evidence of endothelial dysfunction. These changes predate other measures of CVD. Retinal vessel analysis may be utilized as a robust screening tool for identifying survivors at increased risk for developing CVD.
Databáze:	MEDLINE
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