7
|
Samman Tahhan A, Hammadah M, Sandesara PB, Hayek SS, Kalogeropoulos AP, Alkhoder A, Mohamed Kelli H, Topel M, Ghasemzadeh N, Chivukula K, Ko YA, Aida H, Hesaroieh I, Mahar E, Kim JH, Wilson P, Shaw L, Vaccarino V, Waller EK, Quyyumi AA. Progenitor Cells and Clinical Outcomes in Patients With Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004106. [PMID: 28790053 DOI: 10.1161/circheartfailure.117.004106] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endogenous regenerative capacity, assessed as circulating progenitor cell (PC) numbers, is an independent predictor of adverse outcomes in patients with cardiovascular disease. However, their predictive role in heart failure (HF) remains controversial. We assessed the relationship between the number of circulating PCs and the pathogenesis and severity of HF and their impact on incident HF events. METHODS AND RESULTS We recruited 2049 adults of which 651 had HF diagnosis. PCs were enumerated by flow cytometry as CD45med+ blood mononuclear cells expressing CD34, CD133, vascular endothelial growth factor receptor-2, and chemokine (C-X-C motif) receptor 4 epitopes. PC subsets were lower in number in HF and after adjustment for clinical characteristics in multivariable analyses, a low CD34+ and CD34+/CXCR+ cell count remained independently associated with a diagnosis of HF (P<0.01). PC levels were not significantly different in reduced versus preserved ejection fraction patients. In 514 subjects with HF, there were 98 (19.1%) all-cause deaths during a 2.2±1.5-year follow-up. In a Cox regression model adjusting for clinical variables, hematopoietic-enriched PCs (CD34+, CD34+/CD133+, and CD34+/CXCR4+) were independent predictors of all-cause death (hazard ratio 2.0, 1.6, 1.6-fold higher mortality, respectively; P<0.03) among HF patients. Endothelial-enriched PCs (CD34+/VEGF+) were independent predictors of mortality in patients with HF with preserved ejection fraction only (hazard ratio, 5.0; P=0.001). CONCLUSIONS PC levels are lower in patients with HF, and lower PC counts are strongly and independently predictive of mortality. Strategies to increase PCs and exogenous stem cell therapies designed to improve regenerative capacity in HF, especially, in HF with preserved ejection fraction, need to be further explored.
Collapse
Affiliation(s)
- Ayman Samman Tahhan
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Muhammad Hammadah
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Pratik B Sandesara
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Salim S Hayek
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Andreas P Kalogeropoulos
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Ayman Alkhoder
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Heval Mohamed Kelli
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Matthew Topel
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Nima Ghasemzadeh
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Kaavya Chivukula
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Yi-An Ko
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Hiroshi Aida
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Iraj Hesaroieh
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Ernestine Mahar
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Jonathan H Kim
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Peter Wilson
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Leslee Shaw
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Viola Vaccarino
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Edmund K Waller
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA
| | - Arshed A Quyyumi
- From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.S.T., M.H., P.B.S., S.S.H., A.P.K., A.A., H.M.-K., M.T., N.G., K.C., H.A., I.H., J.H.K., P.W., L.S., V.V., A.A.Q.); and Department of Biostatistics and Bioinformatics (Y.-A.K., E.M.) and Department of Hematology and Oncology, Winship Cancer Institute (E.K.W.), Emory University, Atlanta, GA.
| |
Collapse
|