title: Relationship between circulating endothelial progenitor cells and insulin resistance in non-diabetic patients with ischemic chronic heart failure.
abstract: OBJECTIVE
  The objective of this study was to assess a relationship between insulin resistance (IR) and counts of CD45(-)CD34(+), CD14(+)CD309(+), and CD14(+)CD309(+)Tie2(+) phenotyped circulating endothelial progenitor cells (EPCs) in patients with ischemic chronic heart failure (CHF).
  
  
  METHODS
  The study involved 300 CHF patients (186 males) aged 48-62 years with angiografically proven coronary artery disease and/or previously defined myocardial infarction. Insulin resistance was assessed by the homeostasis model assessment for insulin resistance (HOMA-IR). EPC populations were phenotyped by flow cytofluorimetry.
  
  
  RESULTS
  Circulating EPCs counts were statistically significantly lower in CHF patients with IR than in patients without IR. We found that the most valuable multivariable predictors of the depletion of the CD45(+)CD34(+) EPCs were NT-pro-brain natriuretic peptide (BNP) (1.32; 95% CI=1.19-2.77; P=0.001), left ventricular ejection fraction (OR=1.30; 95% CI=1.09-1.60; P=0.002), NYHA class (OR=1.12; 95% CI=1.02-1.19; P=0.001). NT-pro-BNP (OR=1.45; 95% CI=1.15-2.90; P=0.003), left ventricular ejection fraction (OR=1.32; 95% CI=1.11-1.65; P=0.001) were found as powerful predictors for depletion in CD45(-)CD34(+) EPCs. We also identified six independent variables with high predictive value for depletion of CD14(+)CD309(+) EPCs: NT-pro-BNP (OR=1.41; 95% CI=1.15-2.90; P=0.003), left ventricular ejection fraction (OR=1.18; 95% CI=1.10-1.76; P=0.036), NYHA class (OR=1.15; 95% CI=1.07-1.22; P=0.001), hs-C reactive protein (OR=1.02; 95% CI=1.01-1.05; P=0.012). As independent multivariable predictors for depletion in CD14(+)CD309(+)Tie2(+) EPCs were selected five variables: NT-pro-BNP (OR=1.65; 95% CI=1.44-4.70; P=0.006), left ventricular ejection fraction (OR=1.07; 95% CI=1.02-1.12; P=0.018), NYHA class (OR=1.13; 95% CI=1.06-1.21; P=0.001), hs-C-reactive protein (OR=1.08; 95% CI=1.03-1.16; P=0.002).
  
  
  CONCLUSIONS
  IR may be an additional factor contributing decreased circulating level of proangiogenic EPCs in non-diabetic CHF patients.
authors.affiliation: State Medical University, Internal Medicine Department, Zaporozhye, Ukraine. Electronic address: dr_berezin@mail.ru.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Berezin
authors.affiliation: State Medical University, Clinical Pharmacology Department, Zaporozhye, Ukraine.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Kremzer
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D018952:Antigens, CD34 / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D017023:Coronary Angiography; D066026:Endothelial Progenitor Cells / Q000378:metabolism*; D005260:Female; D005434:Flow Cytometry; D006333:Heart Failure / Q000378:metabolism / Q000503:physiopathology*; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D017493:Leukocyte Common Antigens / Q000378:metabolism; D018950:Lipopolysaccharide Receptors / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000378:metabolism / Q000503:physiopathology*; D010641:Phenotype; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D014455:Ukraine
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D018952:Antigens, CD34; D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D017493:Leukocyte Common Antigens; C516769:PTPRC protein, human
keywords: Chronic heart failure; Endothelial progenitor cells; Insulin resistance