Coincidence of moderately elevated N-terminal pro-B-type natriuretic peptide, endothelial progenitor cells deficiency and propensity to exercise-induced myocardial ischemia in stable angina.
OBJECTIVE
To assess endothelial progenitor cells (EPC) counts, a novel prognostic marker, in relation to classical adverse outcome predictors - N-terminal pro-B-type natriuretic peptide (NT-proBNP), impaired left ventricular (LV) relaxation and exercise-induced ischemia - in stable coronary artery disease (CAD) with preserved LV systolic function.


METHODS
We studied 30 non-diabetic men with one-vessel CAD, LV ejection fraction 60% and normal LV diastolic function (n=16) or impaired LV relaxation (by ultrasound including tissue Doppler) (n=14), and 14 non-CAD controls matched for risk profile and medication. CD34+/kinase-insert domain receptor (KDR)+ cells (CD34+/KDR+ cells), a leukocytes subpopulation enriched for EPC, were enumerated by flow cytometry.


RESULTS
CAD patients with abnormal LV relaxation exhibited significantly elevated NT-proBNP and decreased CD34+/KDR+ cells vs. CAD with regular diastolic function and non-CAD controls. An inverse NT-proBNP-CD34+/KDR+ cells relationship was precipitated by the clustering of high resting NT-proBNP and low CD34+/KDR+ cells in the subjects with a lower Duke treadmill score.


CONCLUSIONS
Propensity to symptomatic exertional ischemia may underlie the coincidence of moderately elevated NT-proBNP and EPC deficiency in stable angina. Additionally, chronic subclinical ischemia can also be involved in these associations. These might result from BNP overexpression in the ischemic myocardium and a hypothetical exhaustion of the bone marrow capacity to mobilize EPC at multiple ischemic episodes, thus contributing to NT-proBNP prognostic effect irrespective of hemodynamic factors.
Surdacki
Andrzej
A
2nd Department of Cardiology, Faculty of Medicine, Jagiellonian University, Cracow, Poland. surdacki.andreas@gmx.net
Marewicz
Ewa
E
Rakowski
Tomasz
T
Szumańska
Monika
M
Szastak
Grzegorz
G
Pryjma
Juliusz
J
Dubiel
Jacek S
JS
D053687:Adult Stem Cells / Q000378:metabolism / Q000473:pathology; D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D018952:Antigens, CD34 / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002452:Cell Count; D042783:Endothelial Cells / Q000378:metabolism / Q000473:pathology; D015444:Exercise; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000378:metabolism; D016277:Ventricular Function, Left
D018952:Antigens, CD34; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D040301:Vascular Endothelial Growth Factor Receptor-2