Retinal microvascular signs and recurrent vascular events in patients with TIA or minor stroke.

Autor:	Klyscz P; Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany philipp.klyscz@charite.de., Ihl T; Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany., Laumeier I; Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany., Steinicke M; Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany., Endres M; Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Berlin Institute of Health, Berlin, Germany.; Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany.; German Center for Neurodegenerative Diseases, partner site Berlin, Germany.; German Center for Cardiovascular Research, partner site Berlin, Germany., Michelson G; Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg Medizinische Fakultät, Erlangen, Germany.; Talkingeyes & More GmbH, Erlangen, Germany., Audebert HJ; Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Jazyk:	angličtina
Zdroj:	Stroke and vascular neurology [Stroke Vasc Neurol] 2023 Oct; Vol. 8 (5), pp. 379-386. Date of Electronic Publication: 2023 Mar 01.
DOI:	10.1136/svn-2022-001784
Abstrakt:	Background and Purpose: Retinal pathologies are an independent risk factor for ischaemic stroke, but research on the predictive value of retinal abnormalities for recurrent vascular events in patients with prior stroke is inconclusive. We investigated the association of retinal pathologies with subsequent vascular events. Methods: In a substudy of the Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS) trial, we enrolled patients with recent transient ischaemic attack (TIA) or minor stroke with at least one modifiable risk factor. Primary outcome was the composite of subsequent vascular events. Retinal photographs were taken at baseline and categorised into three different fundus groups by a telemedically linked ophthalmologist. Results: 722 patients participated in the current study and 109 major vascular events occurred. After multivariable adjustments, we did not find a significant association between fundus categories and risk for subsequent vascular events (HRs for moderate vascular retinopathy and vascular retinopathy with vessel rarefaction in comparison to no vascular retinopathy 1.03 (95% CI 0.64 to 1.67), p=0.905 and 1.17 (95% CI 0.62 to 2.20), p=0.626). In a selective post hoc analysis in patients with diabetes mellitus and hypertension, patients with vascular retinopathy with vessel rarefaction had a higher risk for recurrent stroke (HR 24.14 (95% CI 2.74 to 212.50), p=0.004). Conclusions: Retinal changes did not predict major subsequent vascular events in patients with recent TIA or minor stroke. Further studies are needed to examine the utility of fundus photography in assessing the risk of stroke recurrence in patients with diabetes mellitus and hypertension. Competing Interests: Competing interests: PK, TI, IL, MS declare no disclosures or competing interest. ME reports grants from Bayer and fees paid to the Charité from AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Amgen, GSK, Sanofi, Covidien, Novartis, Pfizer, all outside the submitted work. GM reports grants from Bayer, outside the submitted work. HJA has received funding from the Deutsche Forschungsgemeinschaft (DFG), the Federal Ministry of Research and Education (BMBF) and the German Innovation Fund for other projects. He reports personal fees from AstraZeneca, Bayer Vital, Boehringer Ingelheim, Bristol Myers Squibb, Novo Nordisk, Pfizer and Sanofi. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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