Comparison of Monofractal and Multifractal dimensions of Ret
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In the sense of cardiometabolic disease progression, metrics that capture improvements in retinal microvascular structure are useful. Monofractals are commonly used to quantify microvascular topology, despite the fact that it follows more complex multifractal laws. Researchers are looking into the relationship between cardiometabolic influences and mono and multifractals of the retinal microvasculature.

The cross-sectional retrospective study used data from 3000 Middle Eastern participants in the Qatar Biobank. A total of 2333 fundus images (78%) passed quality control and were used for further analysis. The monofractal (Df) and five multifractal metrics were associated with cardiometabolic factors using multiple linear regression and were studied in clinically relevant subgroups.

--Df and multifractals are lowered in function of age, and Df is lower in males compared to females.

--In models corrected for age and sex, Df is significantly associated with BMI, insulin, systolic blood pressure, glycated haemoglobin (HbA1c), albumin, LDL and total cholesterol concentrations.

--Multifractals are negatively associated with systolic and diastolic blood pressure, glucose and the WHO/ISH cardiovascular risk score.

--Df was higher, and multifractal curve asymmetry was lower in diabetic patients (HbA1c more than 6.5%) compared to healthy individuals (HbA1c less than 5.7%).

--Insulin resistance (insulin more than 23 mcU/mL) was associated with significantly lower Df values.

In a Middle Eastern population sample, one or more fractal metrics are associated with sex, age, BMI, systolic and diastolic blood pressure, and biochemical blood measurements. For a more complete microvascular picture, follow-up studies looking at retinal microvascular changes in relation to cardiometabolic risk should look at both monofractal and multifractal metrics.