Key result
Exercise-induced increases in deep capillary plexus vessel density in HFpEF became nonsignificant after adjusting for signal strength (MD 0.48; 95% CI -0.23 to 1.19; P=0.19).
Why the study?
Retinal vessel density on OCTA has been proposed as a biomarker in HFpEF, but the effect of exercise accounting for signal strength needed evaluation.
Does adjusting for signal strength index alter the apparent exercise-associated retinal vessel density changes on OCTA in patients with HFpEF?
Observational (n=20)
Does adjusting for signal strength index alter the apparent exercise-associated retinal vessel density changes on OCTA in patients with HFpEF?
Apparent changes in retinal vessel density after exercise in HFpEF patients are largely artifacts of signal strength variation, highlighting the critical need for signal strength adjustment in OCTA studies.
No post-exercise parafoveal VD change in HFpEF after signal adjustment; hypothesis-generating for OCTA biomarker utility and requires prospective validation.
Background and Objective: Retinal vessel density (VD) on optical coherence tomography angiography (OCTA) has been proposed as a biomarker in heart failure with preserved ejection fraction (HFpEF). This study evaluated VD change after exercise in HF-pEF, accounting for signal strength. Patients and Methods: Patients with HFpEF underwent 3 × 3-mm OCTA before and after a 6-minute walk test. Change in parafoveal VD in superficial (SCP) and deep (DCP) capillary plexuses was modeled with and without adjustment for signal strength index (SSI) and between New York Heart Association (NYHA) functional classes. Results: Among 34 eyes (20 subjects), unadjusted DCP VD increased after exercise (1.27; 95% CI, 0.31 to 2.24; P = .010), more so in NYHA class III than I or II (difference, 2.39; 95% CI, 0.86 to 3.91; P = .002). SSI adjustment attenuated estimates to nonsignificance (overall, 0.48; 95% CI, −0.23 to 1.19; P = .19; NYHA difference, 0.75; 95% CI, −0.65 to 2.16; P = .29). SCP changes were nonsignificant. Conclusion: Postexercise VD changes in HFpEF were largely explainable by signal strength changes. OCTA analyses should adjust for signal strength to distinguish measurement artifact from true vascular differences.
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Shin et al. (2026) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=20). 6-minute walk test vs. Pre-exercise baseline was evaluated on Change in parafoveal vessel density in deep capillary plexus after exercise, adjusted for signal strength index (MD 0.48, 95% CI -0.23 to 1.19, p=.19). Exercise-induced increases in deep capillary plexus vessel density in HFpEF became nonsignificant after adjusting for signal strength (MD 0.48; 95% CI -0.23 to 1.19; P=0.19).
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