Abstract 1945: Levels Of Circulating Progenitor Cells In Patients With Chronic Heart Failure Predict Outcomes
Background: A low level of circulating endothelial progenitor cells (EPCs), a marker of reduced vascular regeneration, is related to worse outcome in patients with coronary heart disease, but little is known on pts with heart failure (HF). The aim was to assess the prognostic value of circulating EPCs in patients with HF.
Methods: In 68 pts enrolled to GISSI-HF trial by 5 Italian Centers and 45 pts from Frankfurt, mononuclear cells from peripheral blood were isolated and plated; after 4 days, adherent cells were incubated with DiI-labeled acetylated LDL, stained with FITC-labeled Ulex europaeus agglutinin I (lectin), and counted as double positive at confocal microscopy. 66 patients had ischemic etiology, 12 were females, 26 had NYHA class >II, median age 64 y (Q1–Q3 56–70y). Cutoffs for EPCs were assessed by ROC.
Results: Mean EPCs in pts with HF 34 ± 7 EPCs/mm2, 2–3 fold lower than in age-matched controls. Over a median of 2.5 years, 12 CV deaths and 47 first hospitalizations for CV reasons were recorded. Levels of EPCs were unrelated to severity of HF, age or sex. After adjustment for clinical variables, creatinine and BNP, EPCs <30/mm2 were associated with a 2-fold higher risk of CV death and hospitalization, as shown by K-M curves (figure⇓) and by Cox multivariate regression. Pts with HF of ischemic etiology gave identical results.
Conclusions: The level of circulating EPCs is an independent predictor of CV death and hospitalization in pts with chronic HF. The assay of this cellular marker of risk can be performed in blood samples collected in a multicenter setting under controlled conditions, and may offer an accessible tool to assess the role of vascular regeneration in the treatment of HF.