EXPANDED FIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BIOMARKERS ASSOCIATED WITH FUTURE CARDIOVASCULAR DISEASE AND MORTALITY IN PATIENTS WITH DIABETIC RETINOPATHY

PURPOSE: To explore associations among expanded field swept-source optical coherence tomography angiography metrics and the development of myocardial infarction, congestive heart failure (CHF), and all-cause mortality in diabetic patients with and without diabetic retinopathy (DR). METHODS: Baseline swept-source optical coherence tomography angiography images (6 × 6 mm, Montage 15 × 15 mm) were assessed for quantitative and qualitative metrics to identify parameters associated with myocardial infarction, CHF, and all-cause mortality. RESULTS: One hundred and seventy-eight eyes from 119 adults with diabetes without DR or with nonproliferative DR or proliferative DR were included (median 44 months, range 3-57 months). Eleven participants (9.2%) had a cardiovascular event (six myocardial infarction, five CHF) and seven (5.9%) died. Neovascularization vessel density (HR = 44.0, 95% confidence interval [CI]: 1.0-1,861.2, P = 0.048) and vitreous hemorrhage (HR = 39.7, 95% CI: 4.0-392.8, P = 0.002) were associated with CHF. Vitreous hemorrhage (HR = 13.5, 95% CI: 3.0-61.2, P = 0.001) and prior treatment with anti-vascular endothelial growth factor injections and panretinal photocoagulation (HR = 11.4, 95% CI: 2.0-66.3, P = 0.007) were associated with cardiovascular disease (CHF or myocardial infarction). Increased skeletonized vessel density of the deep capillary plexus (HR = 1.2, 95% CI: 1.0-1.5, P = 0.026) was associated with mortality. CONCLUSION: Neovascularization vessel density and skeletonized vessel density of the deep capillary plexus on swept-source optical coherence tomography angiography are associated with cardiovascular disease and mortality in patients with DR. These exploratory findings suggest that swept-source optical coherence tomography angiography may be a useful noninvasive tool to identify diabetic patients at increased risk of cardiovascular disease and death.