RESEARCH ARTICLE
Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study Dandan Wang1,2,3,4☯, Yang Li5☯, Yong Zhou1,2,3,4, Cheng Jin6, Qi Zhao5, Anxin Wang1,2,3,4, Shouling Wu6*, Wen Bin Wei5*, Xingquan Zhao1,2,3,4*, Jost B. Jonas7,8
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1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, 2 China National Clinical Research Center for Neurological Diseases, Beijing, China, 3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China, 4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China, 5 Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China, 6 Department of Cardiology, Kailuan Hospital, Tangshan, China, 7 Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing, Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China, 8 Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht- Karls-University, Heidelberg, Germany ☯ These authors contributed equally to this work. * [email protected] (XZ); [email protected] (SLW); [email protected] (WBW)
OPEN ACCESS Citation: Wang D, Li Y, Zhou Y, Jin C, Zhao Q, Wang A, et al. (2017) Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study. PLoS ONE 12(5): e0177277. https://doi.org/10.1371/journal. pone.0177277 Editor: Friedemann Paul, Charite Universitatsmedizin Berlin, GERMANY
Abstract Purpose To examine whether an abnormally thin retinal nerve fiber layer (RNFL) is associated with cerebrovascular insufficiency.
Received: November 17, 2016
Design
Accepted: April 23, 2017
Community-based study.
Published: May 11, 2017 Copyright: © 2017 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper, and a datafile containing the microdata has additionally been uploaded. Funding: This work was supported by a grant from Beijing Medical High Level Academic Leader (2014-2-010, 2015-2017, Xingquan Zhao). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: Jost B. Jonas: Consultant for Mundipharma Co. (Cambridge, UK); Patent holder
Methods The Asymptomatic Polyvascular Abnormalities in Community Study included Chinese aged 40+ years and without histories of cerebrovascular incidents or coronary heart disease. Using transcranial Doppler and carotid duplex ultrasound examination, we assessed presence and degree of an intracranial arterial stenosis (ICAS) and extracranial carotid arterial stenosis (ECAS) and we measured the RNFL thickness by spectral-domain optical coherence tomography.
Results The study included 3,376 participants with a mean age of 54.3±10.3 years. Thinner RNFL was significantly correlated with a higher prevalence of ECAS (P = 0.035; standardized regression coefficient beta:-0.04; non-standardized regression coefficient B:-0.99; 95% confidence intervals(CI):-1.90,-0.07), after adjusting for age (P100 cm/s for the posterior cerebral artery and vertebra-basilar artery, and >120 cm/s for the siphon of the internal carotid artery. An ECAS was considered a stenosis of equal to or more than 50% of the extracranial common carotid artery or extracranial internal carotid artery. The severity of the stenosis was graded based on the recommendations made by the Society of Radiologists in Ultrasound Consensus Conference, as 69% and occlusion [10]. Carotid artery plaques defined as a focal structure either encroaching into the arterial lumen of at least 0.5 mm or 50% of the surrounding intima-media thickness value, or demonstrating a thickness of 1.5 mm from the intima-lumen interface to the media adventitia interface. Each study participant underwent an interview performed by trained investigators on the basis of a standardized questionnaire (####Questionnaire in Chinese,” and “Questionnaire Translated into English###############). Smoking was defined as at least one cigarette per day for more than a year. Alcohol consumption was considered an intake of at least 80 g of liquor a day for more than 1 year. Smoking or drinking cessation was considered only if it lasted for at least 1 year. Body weight and body height were measured, and the body mass index (BMI) was calculated as body weight (kg) divided by the square of height (m2) [11]. Arterial hypertension was defined as self- reported history of hypertension, taking antihypertensive medication or by a systolic blood pressure of 140 mm Hg or a diastolic blood pressure of 90 mm Hg. Diabetes mellitus was defined by a self-reported history, current treatment with insulin or oral hypoglycemic agents, or a fasting blood glucose concentration 7.0mmol/l. Dyslipidemia was defined as a self-reported history, current use of cholesterol lowering medicine, or a total cholesterol level 6.22 mmol/l or triglyceride 2.26mmol/l or low density lipoprotein 4.14mmol/l [12]. Spectral-domain OCT images were taken from the optic nerve head, macula and adjacent retina (iVue SD-OCT, Optovue Inc., Fremont, California, USA). The iVue SD-OCT used a super luminescent diode scan with a center wavelength of 840 ± 10 nm to provide high resolution images. A 6 x 6 mm2 raster scan was centered on the optic disc and macula. All OCT scans were obtained through undilated pupils. Quality assurance checks were performed. Images with failures of the segmentation of the RNFL, motion artifacts, poor focusing, a scan score index
Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study Dandan Wang1,2,3,4☯, Yang Li5☯, Yong Zhou1,2,3,4, Cheng Jin6, Qi Zhao5, Anxin Wang1,2,3,4, Shouling Wu6*, Wen Bin Wei5*, Xingquan Zhao1,2,3,4*, Jost B. Jonas7,8
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1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, 2 China National Clinical Research Center for Neurological Diseases, Beijing, China, 3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China, 4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China, 5 Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China, 6 Department of Cardiology, Kailuan Hospital, Tangshan, China, 7 Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing, Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China, 8 Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht- Karls-University, Heidelberg, Germany ☯ These authors contributed equally to this work. * [email protected] (XZ); [email protected] (SLW); [email protected] (WBW)
OPEN ACCESS Citation: Wang D, Li Y, Zhou Y, Jin C, Zhao Q, Wang A, et al. (2017) Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study. PLoS ONE 12(5): e0177277. https://doi.org/10.1371/journal. pone.0177277 Editor: Friedemann Paul, Charite Universitatsmedizin Berlin, GERMANY
Abstract Purpose To examine whether an abnormally thin retinal nerve fiber layer (RNFL) is associated with cerebrovascular insufficiency.
Received: November 17, 2016
Design
Accepted: April 23, 2017
Community-based study.
Published: May 11, 2017 Copyright: © 2017 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper, and a datafile containing the microdata has additionally been uploaded. Funding: This work was supported by a grant from Beijing Medical High Level Academic Leader (2014-2-010, 2015-2017, Xingquan Zhao). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: Jost B. Jonas: Consultant for Mundipharma Co. (Cambridge, UK); Patent holder
Methods The Asymptomatic Polyvascular Abnormalities in Community Study included Chinese aged 40+ years and without histories of cerebrovascular incidents or coronary heart disease. Using transcranial Doppler and carotid duplex ultrasound examination, we assessed presence and degree of an intracranial arterial stenosis (ICAS) and extracranial carotid arterial stenosis (ECAS) and we measured the RNFL thickness by spectral-domain optical coherence tomography.
Results The study included 3,376 participants with a mean age of 54.3±10.3 years. Thinner RNFL was significantly correlated with a higher prevalence of ECAS (P = 0.035; standardized regression coefficient beta:-0.04; non-standardized regression coefficient B:-0.99; 95% confidence intervals(CI):-1.90,-0.07), after adjusting for age (P100 cm/s for the posterior cerebral artery and vertebra-basilar artery, and >120 cm/s for the siphon of the internal carotid artery. An ECAS was considered a stenosis of equal to or more than 50% of the extracranial common carotid artery or extracranial internal carotid artery. The severity of the stenosis was graded based on the recommendations made by the Society of Radiologists in Ultrasound Consensus Conference, as 69% and occlusion [10]. Carotid artery plaques defined as a focal structure either encroaching into the arterial lumen of at least 0.5 mm or 50% of the surrounding intima-media thickness value, or demonstrating a thickness of 1.5 mm from the intima-lumen interface to the media adventitia interface. Each study participant underwent an interview performed by trained investigators on the basis of a standardized questionnaire (####Questionnaire in Chinese,” and “Questionnaire Translated into English###############). Smoking was defined as at least one cigarette per day for more than a year. Alcohol consumption was considered an intake of at least 80 g of liquor a day for more than 1 year. Smoking or drinking cessation was considered only if it lasted for at least 1 year. Body weight and body height were measured, and the body mass index (BMI) was calculated as body weight (kg) divided by the square of height (m2) [11]. Arterial hypertension was defined as self- reported history of hypertension, taking antihypertensive medication or by a systolic blood pressure of 140 mm Hg or a diastolic blood pressure of 90 mm Hg. Diabetes mellitus was defined by a self-reported history, current treatment with insulin or oral hypoglycemic agents, or a fasting blood glucose concentration 7.0mmol/l. Dyslipidemia was defined as a self-reported history, current use of cholesterol lowering medicine, or a total cholesterol level 6.22 mmol/l or triglyceride 2.26mmol/l or low density lipoprotein 4.14mmol/l [12]. Spectral-domain OCT images were taken from the optic nerve head, macula and adjacent retina (iVue SD-OCT, Optovue Inc., Fremont, California, USA). The iVue SD-OCT used a super luminescent diode scan with a center wavelength of 840 ± 10 nm to provide high resolution images. A 6 x 6 mm2 raster scan was centered on the optic disc and macula. All OCT scans were obtained through undilated pupils. Quality assurance checks were performed. Images with failures of the segmentation of the RNFL, motion artifacts, poor focusing, a scan score index
