Dynamic and structural ophthalmic evaluation of continuous-flow left ventricular assist device patients

Purpose: To assess retinal parameter changes, and their association with adverse events, in patients with continuous-flow left ventricular assist devices (cfLVAD) via ophthalmic imaging. Methods: Patients with cfLVADs (n=9) and heart failure (HF) (n=9) were studied. Optical coherence tomography (OCT) and OCT angiography were performed with Spectralis® OCT imaging (Heidelberg Engineering, GmbH, Heidelberg, Germany). The Dynamic Vessel Analyser (Imedos, Jena, Germany) measured retinal vessel diameter over 100 seconds. Optos Silverstone (Nikon Healthcare Japan, Inc, Tokyo, Japan) captured ultra-widefield retinal images. Adverse events were recorded. Results: The cfLVAD group (median support duration: 48.8 weeks [25% quartile: 22.5 weeks - 75% quartile: 67.5 weeks]) had increased deep capillary plexus (DCP) foveal avascular zone (FAZ) area relative to the HF controls (1.32 mm² vs 0.75 mm², p=0.018). Deep capillary plexus FAZ perimeter ([β coefficient, 95% credible interval], 0.56±0.29, 0.06–0.74), DCP vessel density (0.50±0.29, 0.06–1.21), SVP vessel density (0.20±0.11, <0.01–0.45), retinal venous pulse amplitude (0.75±0.40, 0.05–1.62) and venous standard deviation (1.08±0.56, 0.10–2.27) were associated with stroke. Pulsatility index (odds ratio, 95% confidence interval [CI]) was a predictor for retinal haemorrhage (0.066, <0.001–0.904). Retinal venous standard deviation (odds ratio, 95% CI) was a predictor for retinal nerve fibre layer thickness abnormalities (<0.001, <0.001–0.824). Conclusion: Continuous-flow results in dynamic, and possibly structural, retinal parameter changes associated with stroke. This has potential to inform outcomes.