The following is a summary of “Retinal Microvasculature: A Potential Window Into Heart Failure Prevention” published in the November 2022 issue of Heart Failure by Chaikijurajai et al.

It has been demonstrated that endothelial dysfunction and microvascular illness play a significant role in the onset and progression of heart failure (HF). Unlike any other method, imaging of the retina allows for a noninvasive evaluation of retinal microcirculation, vessel characteristics, and vascular structure and function. 

There is mounting evidence linking changes in left ventricular structure and function in stage B HF and the incident development of symptomatic HF in the general population to retinal vessel diameter, microvascular features, and vascular characteristics retrieved from several imaging modalities. Furthermore, dynamic retinal vascular analysis has demonstrated phenotype-based distinctions among HF patients. 

Retinal imaging is a promising noninvasive tool to prevent HF and risk stratify those at risk of developing HF, especially with the advent of rapid image acquisition devices (e.g., nonmydriatic widefield systems and smartphone-based retinal cameras) and the integration of artificial intelligence-based interrogation/assessment techniques. The clinical importance and promising efficacy of retinal imaging in HF are discussed, together with the current information on changes to the retinal microvasculature.