Quantification of Retinal Vessel Myogenic Constriction in Response to Blood Pressure Peaks: Implications for Flicker Light-Induced Dilatation

Lukas Streese, Anja Vaes, Denis Infanger, Ralf Roth, Henner Hanssen, Lukas Streese, Anja Vaes, Denis Infanger, Ralf Roth, Henner Hanssen

Abstract

Background/aims: Flicker-light induced retinal vessel dilatation (FID), a marker of microvascular endothelial function, has been shown to be blunted in sedentary cardiovascular risk patients (SR) as well as healthy physically active individuals (HA). This study aimed to quantify the retinal myogenic response to blood pressure (BP) peaks and its effects on consecutive FID for differentiation of microvascular health.

Methods: Ten HA and eleven SR with a previously established restriction of arteriolar FID (aFID) (<2.2%) were invited in order to assess BP-induced myogenic constriction following a standardized handgrip task and a consecutive FID. BP was measured beat-to-beat.

Results: The complete dataset of nine HA (3 female, mean age 65 years) and nine SR (5 female, mean age 61 years) individuals was analyzed. The central retinal arteriolar diameter equivalent (CRAE) was 183 ± 11 μm for HA and 176 ± 20 μm for SR. Initial baseline aFID was 1.6 ± 0.4% in HA and 1.6 ± 0.7% in SR. Systolic (p = 0.334) and diastolic (p = 0.245) BP increase following the handgrip task was in the range of 20-30% and comparable in both groups. BP increase was followed by a significantly higher arteriolar (-2.9 ± 1.3% vs. -1.3 ± 0.6%, p < 0.01) myogenic constriction in HA compared to SR. Moreover, in the consecutive assessment of FID directly after the BP-induced vessel constriction, aFID (4.1 ± 2.0% vs. 1.6 ± 0.9%, p < 0.01) was higher in HA compared to SR.

Conclusion: Initial baseline aFID was blunted in HA and SR. Retinal myogenic constriction was impaired in SR compared to HA. The consecutive aFID after BP-induced myogenic constriction recovered in HA but remained blunted in SR. Additional assessment of retinal myogenic constriction needs to be considered to improve CV risk stratification and reduce false-positive findings of endothelial dysfunction in otherwise healthy active individuals.

Clinical trial registration: ClinicalTrials.gov: NCT03986892 (https://ichgcp.net/clinical-trials-registry/NCT03986892).

Keywords: baseline diameter; cardiovascular risk; endothelial function; microvascular dysfunction; retinal vessel analysis.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Streese, Vaes, Infanger, Roth and Hanssen.

Figures

FIGURE 1
FIGURE 1
Examples of arteriolar median curves for DVA protocol I (A) and DVA protocol II (B). DVA protocol I consisted of 50 s baseline recording followed by 20 s flicker light application and 80 s at rest (A). DVA protocol II consisted of 50 s baseline recording, 40 s handgrip strength task at 30% 1RM, 30 s all-out handgrip strength task, 10 s at rest followed by 20 s of flicker light and a rest period of 80 s. DVA, dynamic retinal vessel analysis; aFID, maximal arteriolar flicker light-induced dilatation; aCON, maximal arteriolar vessel constriction after flicker stimulation; aMC, maximal arteriolar myogenic constriction before the flicker; aRA, maximal arteriolar range between arteriolar myogenic constriction and aFID; 1RM, one repetition maximum; BP, blood pressure.
FIGURE 2
FIGURE 2
Setup for dynamic retinal vessel analysis (DVA) with the Dynamic Vessel Analyzer (DVA®; Imedos Systems GmbH, Jena, Germany) and a fundus camera (450FF, Carl Zeiss, Jena, Germany). Blood pressure was measured beat-to-beat on the middle finger of the right hand with the Finapres® (Finapres Medical Systems B.V., Enschede, Netherlands). The Leonardo Mechanograph GF® device (Novotec Medical GmbH, Pforzheim, Germany) on the left hand was used to increase the blood pressure of the participants. The produced power was continuously controlled using the Leonardo Mechanography BAS v4.4 software.
FIGURE 3
FIGURE 3
Arteriolar and venular median curves for DVA protocol I (A) and DVA protocol II (B) of one representative HA and SR participant. DVA protocol I consisted of 50 s baseline recording followed by 20 s flicker light application and 80 s at rest (A). DVA protocol II consisted of 50 s baseline recording, 40 s handgrip strength task at 30% 1RM, 30 s all-out handgrip strength task, 10 s at rest followed by 20 s of flicker light and a rest period of 80 s. DVA; dynamic retinal vessel analysis; HA, healthy active; SR, sedentary patients with increased cardiovascular risk.
FIGURE 4
FIGURE 4
Association of maximal arteriolar range and change in mean arteriolar pressure in healthy active individuals (HA) and sedentary cardiovascular risk patients (SR).
FIGURE 5
FIGURE 5
Example for a median time curve of arteriolar diameter and mean arteriolar pressure, calculated from three cycles of DVA protocol II of one participant. DVA; dynamic retinal vessel analysis; MAP, mean arteriolar pressure; 1RM, one repetition maximum.

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