Retinal Vasculature Fractal and Stroke Mortality

Fractal analysis is a method of quantifying the branching complexity and density of the retinal vessels. We hypothesized that reduced fractal dimension, signifying a sparser vascular network, is associated with long-term stroke mortality. We examined the relationship of fractal dimension and stroke...

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Bibliographic Details
Published in:Stroke (1970) Vol. 52; no. 4; p. 1276
Main Authors: Liew, Gerald, Gopinath, Bamini, White, Andrew J, Burlutsky, George, Yin Wong, Tien, Mitchell, Paul
Format: Journal Article
Language:English
Published: United States 01.04.2021
Subjects:
hypoxia
hypertension
microcirculation
fractals
retinal vessels
ISSN:1524-4628, 1524-4628
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Summary:Fractal analysis is a method of quantifying the branching complexity and density of the retinal vessels. We hypothesized that reduced fractal dimension, signifying a sparser vascular network, is associated with long-term stroke mortality. We examined the relationship of fractal dimension and stroke mortality in a prospective, population-based cohort of 3143 participants aged 49 years or older. Fractal dimension was measured from digitized fundus photographs using a computer-automated method. Stroke mortality was documented from Australian National Death Index records. We defined reduced fractal dimension as values in the lowest quartile. Over 12 years, there were 132 (4.2%) stroke-related deaths. Stroke-related mortality was higher in participants with reduced fractal dimension (lowest quartile) compared with the highest quartile (7.7% versus 1.3%, <0.01). After controlling for age, gender, smoking, blood pressure, history of stroke, and other factors, participants with reduced fractal dimension had higher stroke mortality (hazard ratio, 2.42 [95% CI, 1.15-5.07], lowest versus highest quartile). When modeled as a continuous variable, reduced fractal dimension was associated with increased stroke mortality (multivariable-adjusted hazard ratio, 1.26 [95% CI, 1.06-1.51], per SD decrease). Reduced retinal vascular fractal dimension is independently associated with 12-year stroke mortality. Reduced fractal dimension may indicate cerebral tissue hypoxia and increased risk of stroke.
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ISSN:1524-4628
1524-4628
DOI:10.1161/STROKEAHA.120.031886