Patients at Elevated Risk for Heart Failure Exhibit Reduced Retinal Perfusion

<b>Purpose:</b> To determine whether alterations in retinal microvasculature seen on optical coherence tomography angiography (OCTA) can be used to identify individuals at elevated risk for heart failure. <b>Methods:</b> Patients with a 10-year risk of developing heart failure greater than 5%, as calculated by the Pooled Cohort Equation to Prevent Heart Failure, were enrolled in this prospective cohort study (n = 26; 49 eyes). Individuals with clinical heart failure or ocular opacities were excluded. Age-matched healthy controls (n = 22; 32 eyes) were identified from a departmental database. OCTA imaging segmented the full retinal slab into superficial capillary plexuses and deep capillary plexuses. The foveal avascular zone was manually delineated using FIJI, and vessel density and vessel length density were measured with a FIJI macro. OCTA parameters were analyzed using linear mixed-effects models with fixed effects for heart failure risk status, age, sex, hypertension and diabetes, and a random effect for patient. Coefficients for heart failure risk status determined statistical significance, with <i>P</i> values adjusted using the Benjamini-Hochberg procedure. <b>Results:</b> Patients with a 10-year risk of developing heart failure greater than 5% showed a reduction in deep capillary plexus vessel length density (-0.011 ± 0.008; adjusted <i>P</i> = .038) compared with controls. <b>Conclusions:</b> Vessel length density in the deep capillary plexus may be reduced in individuals at elevated risk for heart failure. This study is the first to identify retinal microvascular changes in patients with elevated risk of heart failure, supporting the potential use of OCTA as a noninvasive screening tool for cardiovascular disease.