Cynthia Maldonado-Garcia

Cynthia Maldonado-Garcia, Rodrigo Bonazzola, Enzo Ferrante et al.

Cardiovascular diseases (CVD) are the leading cause of death globally. Non-invasive, cost-effective imaging techniques play a crucial role in early detection and prevention of CVD. Optical coherence tomography (OCT) has gained recognition as a potential tool for early CVD risk prediction, though its use remains underexplored. In this study, we investigated the potential of OCT as an additional imaging technique to predict future CVD events. We analysed retinal OCT data from the UK Biobank. The dataset included 612 patients who suffered a myocardial infarction (MI) or stroke within five years of imaging and 2,234 controls without CVD (total: 2,846 participants). A self-supervised deep learning approach based on Variational Autoencoders (VAE) was used to extract low-dimensional latent representations from high-dimensional 3D OCT images, capturing distinct features of retinal layers. These latent features, along with clinical data, were used to train a Random Forest (RF) classifier to differentiate between patients at risk of future CVD events (MI or stroke) and healthy controls. Our model achieved an AUC of 0.75, sensitivity of 0.70, specificity of 0.70, and accuracy of 0.70, outperforming the QRISK3 score (the third version of the QRISK cardiovascular disease risk prediction algorithm; AUC = 0.60, sensitivity = 0.60, specificity = 0.55, accuracy = 0.55). The choroidal layer in OCT images was identified as a key predictor of future CVD events, revealed through a novel model explainability approach. This study demonstrates that retinal OCT imaging is a cost-effective, non-invasive alternative for predicting CVD risk, offering potential for widespread application in optometry practices and hospitals.

Cynthia Maldonado-Garcia, Arezoo Zakeri, Alejandro F Frangi et al.

Early identification of patients at risk of cardiovascular diseases (CVD) is crucial for effective preventive care, reducing healthcare burden, and improving patients' quality of life. This study demonstrates the potential of retinal optical coherence tomography (OCT) imaging combined with fundus photographs for identifying future adverse cardiac events. We used data from 977 patients who experienced CVD within a 5-year interval post-image acquisition, alongside 1,877 control participants without CVD, totaling 2,854 subjects. We propose a novel binary classification network based on a Multi-channel Variational Autoencoder (MCVAE), which learns a latent embedding of patients' fundus and OCT images to classify individuals into two groups: those likely to develop CVD in the future and those who are not. Our model, trained on both imaging modalities, achieved promising results (AUROC 0.78 +/- 0.02, accuracy 0.68 +/- 0.002, precision 0.74 +/- 0.02, sensitivity 0.73 +/- 0.02, and specificity 0.68 +/- 0.01), demonstrating its efficacy in identifying patients at risk of future CVD events based on their retinal images. This study highlights the potential of retinal OCT imaging and fundus photographs as cost-effective, non-invasive alternatives for predicting cardiovascular disease risk. The widespread availability of these imaging techniques in optometry practices and hospitals further enhances their potential for large-scale CVD risk screening. Our findings contribute to the development of standardized, accessible methods for early CVD risk identification, potentially improving preventive care strategies and patient outcomes.