Affiliations: 2nd Department of Cardiology, Faculty of Medicine,
Jagiellonian University, Cracow, Poland | Department of Immunology, Faculty of Biochemistry,
Biophysics and Biotechnology, Jagiellonian University, Cracow, Poland
Note: [] Corresponding author: Andrzej Surdacki, MD, FESC, 2nd Department
of Cardiology, Jagiellonian University, 17 Kopernika Street, 31-501 Cracow,
Poland. Tel.: +48 12 4247180; Fax: +48 12 4247180; E-mail:
surdacki.andreas@gmx.net
Abstract: Aim: To assess endothelial progenitor cells (EPC) counts, a novel
prognostic marker, in relation to classical adverse outcome predictors –
N-terminal pro{–}B-type natriuretic peptide (NT-proBNP), impaired left
ventricular (LV) relaxation and exercise-induced ischemia – in stable coronary
artery disease (CAD) with preserved LV systolic function. Methods: We
studied 30 non-diabetic men with one-vessel CAD, LV ejection fraction ⩾
60% and normal LV diastolic function (n=16) or impaired LV relaxation
(by ultrasound including tissue Doppler) (n=14), and 14 non-CAD controls
matched for risk profile and medication. CD34+/kinase-insert domain receptor
(KDR)+ cells (CD34+/KDR+ cells), a leukocytes subpopulation enriched for
EPC, were enumerated by flow cytometry. Results: CAD patients with
abnormal LV relaxation exhibited significantly elevated NT-proBNP and decreased
CD34+/KDR+ cells vs. CAD with regular diastolic function and non-CAD
controls. An inverse NT-proBNP–CD34+/KDR+ cells relationship was
precipitated by the clustering of high resting NT-proBNP and low CD34+/KDR+
cells in the subjects with a lower Duke treadmill score. Conclusions: Propensity to symptomatic exertional ischemia may underlie the coincidence of
moderately elevated NT-proBNP and EPC deficiency in stable angina.
Additionally, chronic subclinical ischemia can also be involved in these
associations. These might result from BNP overexpression in the ischemic
myocardium and a hypothetical exhaustion of the bone marrow capacity to
mobilize EPC at multiple ischemic episodes, thus contributing to NT-proBNP
prognostic effect irrespective of hemodynamic factors.
