Avaliação dos diâmetros vasculares retinianos por retinografia com técnica semiautomática de análise da imagem digital em pacientes hipertensos

• Autor(a) principal: Chaves, Daniel Nogueira da Gama
• Data de Publicação: 2015
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/12717
• topic: Retinography; Retinal vessels; Blood pressure; Hypertension; Retinografia; Vasos retinianos; Pressão arterial; Hipertensão; Hipertensão; Diagnóstico por imagem; Pressão arterial; Vasos Retinianos; Veia Retiniana; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::OFTALMOLOGIA

Hypertension is highly prevalent in Brazil and worldwide. The identification of individuals at higher risk of developing target organ damage and clinical outcomes is critical to minimize medical, social and economic impacts. Direct visualization of retinal vessels with retinography seems an attractive technique due to its good reproducibility and its ability to allow visual assessment of vessels similar in structure to renal, coronary and cerebral vascular beds. The technique of non-mydriatic retinography simplifies the acquisition of optic fundus images. The study objective was to evaluate the retinal vessel diameters in hypertensive patients and its association with parameters of ambulatory blood pressure monitoring (ABPM), endothelial function, inflammatory markers and metabolic profile. Cross-sectional study with 37 hypertensive individuals without distinction of gender and race, between 18 and 75 years. Retinography was carried out with a non-mydriatic retinal camera Topcon NW8®. Images were analyzed through a built-in semi-automatic method developed by VAMPIRE software. Retinal vascular diameters were evaluated by the central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE). Arteriovenous ratio (A/V) was obtained by CRAE/CRVE. Office blood pressure was measured by oscillometric method through an automatic Microlife® device and ABPM was performed by a Spacelabs® recorder. Endothelial function was evaluated through peripheral arterial tonometry with Endo-PAT2000® equipment. Laboratory evaluation included determination of the following inflammatory and endothelial function biomarkers: adiponectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, interleukin 6 and vascular growth endothelial factor. A/V ratio was higher and CRVE lower in older as compared to younger subjects. Nocturnal, daytime and 24h diastolic blood pressure (DBP) recorded by ABPM showed a significant direct association with CRVE and an inverse association with A/V ratio and CRAE. After adjustments for confounders, CRAE was the single parameter to retain significance. In the subgroup of patients<60 years old, A/V ratio accentuated its association with DBP and displayed a direct association with nocturnal mean arterial pressure (MAP) and DBP. CRAE was inversely associated with morning surge in MAP. Endothelial function, inflammatory biomarkers and metabolic profile did not correlate with A/V ratio, CRAE or CRVE, except for triglycerides, which showed an inverse association with CRAE after adjustments. These results suggest that retinography with semi-automatic analysis of digital image is able to distinguish different vascular patterns and correlate them with some ABPM variables for which robust evidence of association with clinical outcomes is available. Prospective studies designed to evaluate the ability of retinography to further stratify risk in hypertensive patients seem warranted.