Retinal microvascular changes in microvascular angina: findings from the Australian Heart Eye Study

Gerald Liew*, Paul Mitchell, Joseph Chiha, Adam J. H. Plant, Andrew White, Nichole Joachim, Sarah Wang, George Burlutsky, Pramesh Kovoor, Aravinda Thiagalingam, Bamini Gopinath

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Objective: Microvascular changes in microvascular angina are poorly understood due to difficulties in imaging the coronary microcirculation in vivo. The retinal microvasculature may reflect changes in coronary microcirculation. We assessed microvascular changes in the retina in patients with microvascular angina and compared them with patients with angiographically proven coronary artery disease. Methods: We performed retinal photography and coronary angiography on 915 patients. Retinal vessel calibers were measured using a validated computer-assisted method; coronary artery disease was graded from coronary angiograms. Microvascular angina was defined as angina with <25% stenosis in all coronary epicardial arteries. Results: A total of 139 patients (15.2%) had microvascular angina, while 776 (84.8%) had coronary artery disease. Participants with microvascular angina and coronary artery disease had similar retinal arteriolar and venular calibers. After adjustment for age, ethnicity, mean arterial pressure, diabetes, current smoking, body mass index, and fellow vessel caliber, women with smaller venules were threefold more likely to have microvascular angina than women with larger venules (multivariable-adjusted odds ratio 3.54, 95% confidence interval 1.35 to 9.24, P < 0.01). This difference was not observed in men. Conclusions: Microvascular angina in women was associated with microvascular changes distinct from those in coronary artery disease.

Original languageEnglish
Article numbere12536
Number of pages6
Issue number6
Publication statusPublished - Aug 2019
Externally publishedYes


  • coronary heart disease
  • retinal arterioles
  • retinal microvasculature
  • retinopathy
  • venules


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