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Systemische kardiovaskuläre Risikoabschätzung

Klassisch oder fundusbasiert?

Systemic cardiovascular risk assessment

Conventional or eye fundus-based?

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Zusammenfassung

Es existiert eine Vielzahl internistischer Risikobeurteilungssysteme. Am weitesten verbreitet in Deutschland sind der ESC HeartScore, der Framingham-Score und PROCAM. Diese liefern unterschiedliche Risikoschätzungen und berücksichtigen teilweise unterschiedliche Risikofaktoren. Aufgrund der Homologie der Augengefäße zu den Hirngefäßen bietet die Fundusuntersuchung am Auge einen vielversprechenden Ansatz, um die Risikovorhersage zu verbessern. In großen Kohortenstudien wurden Gefäßveränderungen, unter anderem die arteriovenöse Ratio, sowie Retinopathiezeichen wie Cotton-wool-Herde, Mikroaneurysmata, Punkt- und Fleckblutungen auf ihre Fähigkeit überprüft, kardiovaskuläre Ereignisse vorherzusagen. Während die Retinopathiezeichen einen hohen Vorhersagewert haben, aber selten diagnostiziert werden, können die Gefäßveränderungen in der untersuchten Form nur wenig zur Verbesserung der Risikoprädiktion beitragen. Einige neuere Ansätze mittels statischer wie auch dynamischer Gefäßanalyse sind vielversprechend, müssen aber noch prospektiv validiert werden.

Abstract

Several systemic cardiovascular (CV) risk assessment algorithms exist, of which the ESC HeartScore, Framingham and PROCAM are the most frequently applied in Germany. The risk estimates generated differ and take a number of different risk factors into consideration. Due to existing homology of retinal vessels and brain vessels, eye fundus examination is a promising approach to improving risk prediction. Large cohort studies investigated retinal vascular changes, including arteriovenous ratio, as well as signs of retinopathy such as cotton-wool spots, microaneurysms, or retinal hemorrhages for their ability to predict systemic cardiovascular events. While signs of retinopathy proved to have high predictive power (but are rarely diagnosed,) the retinal vascular changes investigated could contribute little to enhancing systemic CV risk prediction. A number of new and promising approaches based on static and dynamic retinal analysis exist, but still need to be validated prospectively.

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  1. Augenklinik der Ludwig-Maximilians-Universität München, Mathildenstr. 8, 80336, München, Deutschland

    A. Wolf, M. Kernt, A. Kampik &  A.S. Neubauer

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  1. A. Wolf
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  2. M. Kernt
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  3. A. Kampik
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  4. A.S. Neubauer
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Correspondence to A.S. Neubauer.

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Wolf, A., Kernt, M., Kampik, A. et al. Systemische kardiovaskuläre Risikoabschätzung. Ophthalmologe 107, 814–820 (2010). https://doi.org/10.1007/s00347-009-2113-z

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