Left ventricular mass and progenitor cells in chronic heart failure patients

Endothelial Progenitor Cells: An Appraisal of Relevant Data from Bench to Bedside

The mobilization of endothelial progenitor cells (EPCs) into circulation from bone marrow is well known to be present in several clinical settings, including acute coronary syndrome, heart failure, diabetes and peripheral vascular disease. The aim of this review was to explore the current literature focusing on the great opportunity that EPCs can have in terms of regenerative medicine.

Endothelial Progenitor Cells in Heart Failure: an Authentic Expectation for Potential Future Use and a Lack of Universal Definition

Congestive heart failure (CHF) is a prevalent disease (especially among the elderly) with high mortality and morbidity rates. The pathological hallmark of CHF is a loss of cardiomyocytes leading to cardiac fibrosis and dysfunctional cardiac remodeling, which culminates in organ failure. Endothelial progenitor cells (EPCs) are bone marrow-derived cells that contribute to maintenance of the integrity of endothelial wall and protect ischemic myocardium through forming new blood vessels (vasculogenesis) or proliferation of pre-existing vasculature (angiogenesis). Despite its potential, little is known about EPCs and their function in CHF. Here, we define EPC and its role in health and CHF, highlighting their contributions as a cornerstone in the maintenance of a healthy endothelium. Thereafter, we explore the behavior and relevance of EPCs in the pathophysiology of CHF, their prognostic importance, and possible utilization of EPCs as therapy for CHF. Lastly, the restrictions surrounding the use of EPCs in clinical practice will be discussed.

Pattern of endothelial progenitor cells and apoptotic endothelial cell-derived microparticles in chronic heart failure patients with preserved and reduced left ventricular ejection fraction

Background

Chronic heart failure (HF) remains a leading cause of cardiovascular (CV) mortality and morbidity worldwide. The aim of the study was to investigate whether the pattern of angiogenic endothelial progenitor cells (EPCs) and apoptotic endothelial cell-derived microparticles (EMPs) would be able to differentiate HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction.

Methods

One hundred sixty four chronic HF subjects met inclusion criteria. Patients with global left ventricular ejection fraction ≥ 50% were categorized as the HFpEF group (n = 79) and those with ≤ 45% as the HFrEF group (n = 85). Therefore, to compare the circulating levels of biological markers 35 control subjects without HF were included in the study. All control individuals were age- and sex-matched chronic HF patients. The serum level of biomarkers was measured at baseline. The flow cytometric technique was used for predictably distinguishing circulating cell subsets depending on expression of CD45, CD34, CD14, Tie-2, and CD309 antigens and determining endothelial cell-derived microparticles. CD31⁺/annexin V⁺ was defined as apoptotic endothelial cell-derived MPs, MPs labeled for CD105⁺ or CD62E⁺ were determined as MPs produced due to activation of endothelial cells.

Results

In multivariate logistic regression model T2DM (R² = 0.26; P = 0.001), obesity (R² = 0.22; P = 0.001), previous MI (R² = 0.17; P = 0.012), galectin-3 (R² = 0.67; P = 0.012), CD31⁺/annexin V⁺ EMPs (R² = 0.11; P = 0.001), NT-proBNP (R² = 0.11; P = 0.046), CD14⁺ CD309⁺ cells (R² = 0.058; P = 0.001), and CD14⁺ СD309⁺ Tie-2⁺ cells (R² = 0.044; P = 0.028) were found as independent predictors of HFpEF. Using multivariate Cox-regression analysis adjusted etiology (previous myocardial infarction), cardiovascular risk factors (obesity, type 2 diabetes mellitus) we found that NT-proBNP (OR 1.08; 95% CI = 1.03–1.12; P = 0.001) and CD31⁺/annexin V⁺ EMPs to CD14⁺ CD309⁺ cell ratio (OR 1.06; 95% CI = 1.02–1.11; P = 0.02) were independent predictors for HFpEF.

Conclusion

We found that CD31⁺/annexin V⁺ EMPs to CD14⁺ CD309⁺ cell ratio added to NT-proBNP, clinical data, and cardiovascular risk factors has exhibited the best discriminate value and higher reliability to predict HFpEF compared with NT-proBNP and clinical data/cardiovascular risk factors alone.

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Endothelial progenitors and apoptotic endothelial microparticles contribute in regulation of endothelial function

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Heart failure associates with decreased endothelial progenitors and increased apoptotic endothelial microparticles

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Imbalance between endothelial progenitors and apoptotic endothelial microparticles reflects impaired immune phenotype

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Endothelial progenitors to apoptotic endothelial microparticles ratio might be a surrogate predictor of heart failure

We have searched the clinical studies depicted predictive value of progenitor mononuclears and apoptotic endothelial microparticles in heart failure with preserved (HFpEF) and reduced (HFpEF) left ventricular ejection fraction. Our results have shown that simple measurement of circulating pool of endothelial-derived progenitor cells or apoptotic endothelial microparticles were not probably allowed to create novel model for risk stratification of patients with HEpEF. We suggest that CD31⁺/annexin V⁺ EMPs to CD14⁺ CD309⁺ cell ratio might be considered as an essential tool for prediction and individualized medical care of HFpEF patients.