title: Predictive value of apoptotic microparticles to mononuclear progenitor cells ratio in advanced chronic heart failure patients.
abstract: BACKGROUND
  Acutely decompensated chronic heart failure (ADHF) is considered a life-threatening event. Despite contemporary treatment strategies of ADHF, frequent recurrent hospitalizations due to other cardiovascular reasons after discharge of patients from hospital occur. The objective of the study was to examine the prognostic value of circulating endothelial-derived apoptotic microparticles (EMPs) to mononuclear progenitor cells (MPCs) ratio for post-discharge patients with clinical stabilization after ischemic ADHF.
  
  
  METHODS
  We consecutively enrolled 136 patients (62 male) with coronary artery disease (CAD) admitted with a primary diagnosis of ADHF. All patients gave written informed consent for participation in the study. At baseline, all enrolled patients were hemodynamically stable and they had New York Heart Association (NYHA) III/IV classes of ischemic chronic heart failure (CHF). Observation period started at discharge from the hospital and was up to 3 years. Flow cytometry analysis for quantifying the number of EMPs and angiogenic MPCs was used.
  
  
  RESULTS
  Calculated EMP to MPC ratios in survivor and dead patient cohort were 8.4 (95% CI=7.6-9.2) and 78.9 (95% CI=53.0-116.6), respectively (p=0.001). MPCs, EMPs, NYHA class, N-terminal pro-brain natriuretic peptide (NT-proBNP) and increased NT-proBNP>30% within 24-84h of admission period remained statistically significant for all-cause mortality, CHF-related death, and CHF-related rehospitalization, whereas left ventricular ejection fraction and high-sensitivity C-reactive protein for all variables did not. We found that the addition of EPMs to MPCs ratio to the ABC model (NT-pro-BNP, increased NT-pro-BNP>30%) improved the relative integrated discrimination indices by 19.6% for all-cause mortality, by 21.7% for CHF-related death, and by 19.5% for CHF-related rehospitalization.
  
  
  CONCLUSIONS
  We demonstrated that EMP to MPC ratio is considered an important indicator of an imbalance between angiogenic and apoptotic responses with possible relation to cardiovascular outcomes in post-discharge patients with clinical stabilization after ischemic ADHF.
authors.affiliation: Internal Medicine Department, State Medical University, 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
authors.affiliation: State Medical University, Clinical Pharmacology Department, Zaporozhye, Ukraine.
authors.forename: Tatyana A
authors.initials: TA
authors.lastname: Samura
authors.affiliation: State Medical University, Pathology Department, Zaporozhye, Ukraine.
authors.forename: Yulia V
authors.initials: YV
authors.lastname: Martovitskaya
authors.affiliation: Regional Cardiology Center, Zaporozhye, Ukraine.
authors.forename: Yaroslav V
authors.initials: YV
authors.lastname: Malinovskiy
authors.affiliation: Regional Cardiology Center, Zaporozhye, Ukraine.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Oleshko
authors.affiliation: Private Medical Center "Vitacenter", Zaporozhye, Ukraine.
authors.forename: Tatyana A
authors.initials: TA
authors.lastname: Berezina
mesh_terms: D000368:Aged; D017209:Apoptosis; D015415:Biomarkers / Q000097:blood; D055252:Cell-Derived Microparticles / Q000473:pathology*; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000145:classification* / Q000175:diagnosis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013234:Stem Cells / Q000473:pathology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Advanced chronic heart failure; Endothelial-derived apoptotic microparticles; Proangiogenic mononuclear cells; Prognosis