Can retinal changes predict coronary artery disease in elderly hypertensive patients presenting with angina?

Shantha, Ghanshyam Palamaner Subash; Srinivasan, Yadav; Kumar, Anita A.; Salim, Shihas; Prabakhar, Suhas; Rajan, Anish George; Muralidharan, T.R.

doi:10.1016/j.ajem.2009.04.007

« Previous Next »American Journal of Emergency Medicine
Volume 28, Issue 5 , Pages 617-621, June 2010

Can retinal changes predict coronary artery disease in elderly hypertensive patients presenting with angina?☆

Ghanshyam Palamaner Subash Shantha, MD
- General Medicine Department, Sri Ramachandra University, Chennai, Tamilnadu 600087, India
- Corresponding author. Tel.: +91 4424866768.
Yadav Srinivasan, MBBS
- General Medicine Department, Sri Ramachandra University, Chennai, Tamilnadu 600087, India
Anita A. Kumar, MBBS
- General Medicine Department, Sri Ramachandra University, Chennai, Tamilnadu 600087, India
Shihas Salim, MBBS
- General Medicine Department, Sri Ramachandra University, Chennai, Tamilnadu 600087, India
Suhas Prabakhar, MD
- Ophthalmology Department, Sri Ramachandra University, Chennai, Tamilnadu 600087, India
Anish George Rajan, MBBS
- General Medicine Department, Sri Ramachandra University, Chennai, Tamilnadu 600087, India
T.R. Muralidharan, MD
- Department of Cardiology, Sri Ramachandra University, Chennai, Tamilnadu 600087, India

Received 17 February 2009; received in revised form 2 April 2009; accepted 4 April 2009. published online 10 March 2010.

Abstract

Background

The prevalence of coronary artery disease (CAD) has been increasing in India, and so is the population of elderly patients with hypertension. In the predominantly resource-poor setting prevailing in India, this study is an effort to analyze the accuracy of retinal changes in predicting CAD among a cohort of elderly patients with hypertension presenting to the emergency department with angina.

Methods

A total of 72 elderly patients with hypertension older than 65 years presenting to the emergency department with acute angina were studied. Optic fundi were assessed for retinopathy after pupillary dilatation, which were photographed. All patients underwent coronary angiogram, and the presence or absence of CAD was determined.

Results

Mean ± SD age of the participants was 72.95 ± 6.51 years, and there were 39 men (54.2%) and 33 women (45.8%). Prevalence of CAD and retinopathy was 40.8% and 30.6%, respectively. Coronary artery disease showed a strong association with retinopathy (P < .0001). Male sex (P = .035), microalbuminuria (P = .025), and increased high-sensitivity C-reactive protein (P = .001) were identified as risk factors for CAD. Tests of accuracy for retinopathy as a predictor of CAD showed a likelihood ratio of a positive test and likelihood ratio of a negative test of 3.92 and 0.52, respectively. Area under the receiver operating characteristics curve was 70.6%.

Conclusion

Prevalence of CAD (40.8%) and retinopathy (30.6%) was quite high in our cohort of elderly patients with hypertension. Retinal changes of any grade have a moderate accuracy in predicting CAD and, hence, may be used as an early screening tool in a resource poor setting.