Circulating Endothelial Progenitor Cells and Clinical Outcome in Patients with Aortic Stenosis

Abstract

BackgroundAortic stenosis (AS) is the most common valvular disease. Endothelial progenitor cells (EPCs) have a role in the repair of endothelial surfaces after injury. Reduced numbers of EPCs are associated with endothelial dysfunction and adverse clinical events, suggesting that endothelial injury in the absence of sufficient repair by circulating EPCs promotes the progression of vascular and possibly valvular disorders. The aim of this study was to assess EPC number in patients with AS and to study the predictive value of their circulating levels on prognosis.MethodsThe number of EPCs was determined by flow cytometry in 241 patients with AS and a control group of 73 pts. Thirty-eight, 52 and 151 patients had mild, moderate and severe AS, respectively. We evaluated the association between baseline levels of EPCs and death from cardiovascular causes during follow up.ResultsEPC level was significantly higher in patients with AS compared to the control group (p = 0.017). Two hundred and three patients with moderate and severe AS were followed for a median of 20 months. One hundred and twenty patients underwent an intervention. Thirty four patients died during follow up, 20 patients died due to cardiac causes. Advanced age, the presence of coronary artery disease, AS severity index (combination of high NYHA class, smaller aortic valve area and elevated pulmonary artery pressure) and a low EPC number were predictors of cardiac death in the univariate analysis. Multivariate logistic regression model identified low EPCs number and AS severity index as associated with cardiac death during follow up (p = 0.026 and p = 0.037, respectively).ConclusionsEPC number is increased in patients with AS. However, in patients with moderate or severe AS a relatively low number of EPCs is associated with cardiac death at follow up. These results may help to identify AS patients at increased cardiovascular risk.

Reduced Number and Activity of Circulating Endothelial Progenitor Cells in Acute Aortic Dissection and Its Relationship With IL-6 and IL-17

“…The results showed that AAD patients had decreased number and migration or proliferation of EPCs. However, our findings may be the different from that of Van Spyk E N's ( 37 ), and the possible reasons may be as follows: First, there is a difference in enrolled subjects. although commonly pathogenesis of AAD is atherosclerosis and share similar as the abdominal aortic aneurysm (AAA).…”

“…Numerous studies have indicated that the EPCs may predict outcomes in cardiovascular disease ( 35 , 36 ). It has been proven that the levels of CD34+ cells are altered in patients with abdominal aortic aneurysms compared with patients with peripheral vascular disease, and the CD34+ cells were correlated with aneurysm diameter ( 37 , 38 ). However, few studies focus on the relationship between circulating EPCs and AAD.…”

Low Pre-Treatment Count of Circulating Endothelial Progenitors as a Prognostic Biomarker of the High Risk of Breast Cancer Recurrence

“…Shimoni et al observed that low circulating EPCs levels were associated with cardiac death in patients with aortic stenosis (AS). They suggested that the lower numbers of circulating EPCs may be due to increased cell senescence as well as stimulation of circulating EPCs apoptosis in AS patients [23].…”

Circulating stem cells and cardiovascular outcomes: from basic science to the clinic

“…Low CD34 þ VEGFR2 þ EPCs portended adverse cardiovascular outcomes in patients with aortic stenosis. 95 Additionally, low CD34 þ , CD133 þ , and CD34 þ CD133 þ HSPCs are independently associated with a nearly two-fold risk of cardiovascular events in diabetic individuals, 96 and CSC depletion was associated with adverse cardiovascular outcomes among Asian patients on haemodialysis. 97,98 Figure 4 shows the forest plot of an updated meta-analysis of longitudinal studies involving 100þ patients (from Supplementary material online, Table S1) and reporting poolable estimates of the hazard ratio for cardiovascular events, cardiovascular death, and all-cause death associated with low CSC levels.…”