Retinal microvascularisation abnormalities have been suggested to reflect severity of cardiovascular diseases. In patients with acute coronary syndrome (ACS), a low retinal vascular density, measured by OCT-angiography, has been strongly associated with cardiovascular risk scores and altered LVEF, beyond the classical risk factors. However, the vascular and hemodynamic determinants of RVD and their evolution after the acute event remain to be investigated.

Our study prospectively included patients admitted in a university hospital for an ACS, from May to October 2017. Retinal vascular density (RVD), intraocular pressure (IOP) and hemodynamic parameters including mean arterial pressure (MAP), and cardiac output from echocardiographic measurements were performed at the during hospitalization and three months later.

Among the 25 patients included, 87% were men, with a mean age of 62±11y, AHA score at 18.7 and the mean LVEF at 55(48–60)%. RVD was inversely correlated with AHA score (r=−0.335, P=0.034). Between acute phase and 3 months follow-up, ocular parameters including RVD (19.7±2.6mm⁻¹ vs. 19.3±2.2mm⁻¹, P=0.569), IOP (13.7±2.7mmHg vs. 14.3±3,6mmHg, P=0.193), and cardiac parameters, cardiac output 2.43±0.76L/min/m² vs. 2.55±0.71L/min/m², and LVEF (55±10% to 56±7%, P=0.129) remained stable. No significant association was found between RVD and Ocular Perfusion Pressure at the acute phase or at 3 months. Moreover, no correlation was found between RVD and cardiac output, neither at the acute phase nor 3 months later.

Our prospective study shows that in patients with ACS, retinal vascular density measured by OCT-A is independent from the hemodynamic status and from the left ventricular function. Moreover, no significant variation was observed between acute and three months later RVD values, strongly suggesting that this measurement mainly reflects a chronic alteration of the microvascular system.