PURPOSE: Heart failure is one of the most common cardiac conditions. Alterations of microperfusion have been linked to heart failure. Optical coherence tomography angiography (OCTA) offers the opportunity to study microperfusion in a non invasive manner. The purpose of this study was to evaluate the retinal and optic nerve head (ONH) perfusion in patients with systolic chronic heart failure (CHF) compared to healthy control subjects.

METHODS: 27 eyes of 27 patients with CHF (study group) and 31 eyes of 31 healthy subjects (control group) were prospectively included in this study. CHF Patients had an ejection fraction (EF) < 50% and were classified according to New York Heart Association (NYHA) class. OCT-A was performed using RTVue XR Avanti with AngioVue (Optovue, Inc, Fremont, California, USA). The area of the foveal avascular zone (FAZ) and flow density (FD) data in the superficial and deep retinal OCT-angiogram of the macula and in the radial peripapillary capillary network (RPC) were extracted and analysed.

RESULTS: There was no significant difference in  the signal strength index between the study group and the control group. The difference in the area of the foveal avascular zone between the two groups was also not significant. However, the flow density (whole en face) in the ONH (RPC) in the study group was significantly lower compared to the control group (study group 1 = 48.40 ±2.48 (49.0 [46.7, 50.3]); control group = 50.15±1.85 (50.6 [48.5, 51.70]); p = 0.008). There was a significant correlation between EF and the macular flow density (whole en face). Flow density also correlated with NYHA class.

CONCLUSIONS: Patients with CHF showed reduced flow density compared to healthy controls. The reduced FD correlated with the EF and NYHA class suggesting that CHF patients show signs of microperfusion alterations.