Association between deep learning measured retinal vessel calibre and incident myocardial infarction in a retrospective cohort from the UK Biobank

• Published in: BMJ open Vol. 14; no. 3; p. e079311
• Main Authors: Wong, Yiu Lun, Yu, Marco, Chong, Crystal, Yang, Dawei, Xu, Dejiang, Lee, Mong Li, Hsu, Wynne, Wong, Tien Y, Cheng, Chingyu, Cheung, Carol Y
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 21.03.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Algorithms; Antihypertensives; Artificial Intelligence; Biobanks; Biological Specimen Banks; Blood pressure; Cardiovascular imaging; Cholesterol; Datasets; Deep Learning; Diabetes; Diabetes Mellitus; Diagnostic Imaging; Drugs; Heart attacks; Humans; Male; Medical diagnosis; Mortality; Myocardial infarction; Myocardial Infarction - epidemiology; Ophthalmology; Population; Prospective Studies; Retinal Vessels; Retrospective Studies; Risk Factors; Self report; Socioeconomic factors; Socioeconomic status; UK Biobank; Veins & arteries; Vetreoretinal; White people; United Kingdom > UK; Singapore; Myocardial infarction; OPHTHALMOLOGY; Diagnostic Imaging; Cardiovascular imaging; Vetreoretinal
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-079311

BackgroundCardiovascular disease is a leading cause of global death. Prospective population-based studies have found that changes in retinal microvasculature are associated with the development of coronary artery disease. Recently, artificial intelligence deep learning (DL) algorithms have been developed for the fully automated assessment of retinal vessel calibres.MethodsIn this study, we validate the association between retinal vessel calibres measured by a DL system (Singapore I Vessel Assessment) and incident myocardial infarction (MI) and assess its incremental performance in discriminating patients with and without MI when added to risk prediction models, using a large UK Biobank cohort.ResultsRetinal arteriolar narrowing was significantly associated with incident MI in both the age, gender and fellow calibre-adjusted (HR=1.67 (95% CI: 1.19 to 2.36)) and multivariable models (HR=1.64 (95% CI: 1.16 to 2.32)) adjusted for age, gender and other cardiovascular risk factors such as blood pressure, diabetes mellitus (DM) and cholesterol status. The area under the receiver operating characteristic curve increased from 0.738 to 0.745 (p=0.018) in the age–gender-adjusted model and from 0.782 to 0.787 (p=0.010) in the multivariable model. The continuous net reclassification improvements (NRIs) were significant in the age and gender-adjusted (NRI=21.56 (95% CI: 3.33 to 33.42)) and the multivariable models (NRI=18.35 (95% CI: 6.27 to 32.61)). In the subgroup analysis, similar associations between retinal arteriolar narrowing and incident MI were observed, particularly for men (HR=1.62 (95% CI: 1.07 to 2.46)), non-smokers (HR=1.65 (95% CI: 1.13 to 2.42)), patients without DM (HR=1.73 (95% CI: 1.19 to 2.51)) and hypertensive patients (HR=1.95 (95% CI: 1.30 to 2.93)) in the multivariable models.ConclusionOur results support DL-based retinal vessel measurements as markers of incident MI in a predominantly Caucasian population.