Abstract 15961: Endothelial Function is Associated with Stem Cell Mobilization in Patients with Advanced Chronic Heart Failure
Background: Chronic heart failure (CHF) is characterized by reduced cardiac output and impaired peripheral blood flow, which diminishes endothelial shear stress and consequently flow mediated dilation. The aim of our study was to find out weather endothelial function is associated with stem cell mobilization in patients with CHF.
Methods: In a prospective study we enrolled 34 patients with chronic heart failure (NYHA II - IV, LVEF<40%) who underwent 5-day bone marrow stimulation with daily subcutaneous injections of G-CSF (5 μ g/kg bid). On the fifth day we measured peripheral blood CD34+ cell count. Before beginning of the stimulation ultrasound measurement of flow mediated dilation (FMD) of the brachial artery was preformed. Poor steam cell mobilization was defined as peripheral CD34+ cell count ≤ 40 million per liter.
Results: Good CD34+ mobilization was present in 22 patients (65%). Good and poor mobilizators did not differ with regards to age (54,5±7,2 vs 55,5±13,2 years; p=0,77) and LVEF (31,5±7,6 vs 28,7±6,2 %; p=0,31). On the other hand good mobilizators had lower NT-pro BNP (1449±1442 vs 4632±6926 pg/ml; P=0,026), serum urea (6,8±1,8 vs 9,5±4,0 mmol/l ; p=0,01), serum creatinine (85,5±20,6 vs 102,3±27,0 mmol/l; p=0,026) and better exercise capacity (6 minute walking test 479±77 vs 376±118 m; p=0,006), LVOT VTI (15,3±3,7 vs 12,2±5,0 cm; p=0,05) and FMD (10,2±3,9 vs 2,5±3,4% years; P=0,000004). On multivariate analysis FMD emerged as only independent predictor of CD34+ mobilization (r=0,56; p=0,002).
Conclusions: Endothelial function measured as flow mediated dilation of the brachial artery is the only predictor of stem cells mobilization by subcutaneous injections of G-CSF in patients with hearth failure in NYHA classes II - IV. Since CD34+ antigen is expressed both on hematopoietic progenitor cells and vascular endothelium from many tissues, FDM could serve as noninvasive test to predict good stem cells mobilizators.
- © 2012 by American Heart Association, Inc.