Predicting cardiovascular disease risk using retinal optical coherence tomography imaging.

Introduction: 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 noninvasive method of detecting microvascular alterations that might enable earlier identification and targeting of at-risk patients. In this study, we investigated the potential of OCT as an additional imaging technique to predict future CVD events. Methods: We analyzed 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 structural and morphological features of retinal and choroidal 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. Results: Our model achieved an AUC of 0.75, sensitivity of 0.70, specificity of 0.70, and accuracy of 0.70. The choroidal layer in OCT images was identified as a key predictor of future CVD events, revealed through a novel model explainability approach. Discussion: Our findings demonstrate the potential of retinal OCT imaging, when combined with advanced deep learning methods, as a predictive tool for identifying individuals at increased risk of CVD events.