Abdel Hamid Magdy, Bakhoum Sameh W G, Sharaf Yasser, Sabry Dina, El-Gengehe Ahmed T, Abdel-Latif Ahmed
Department of Cardiology, University of Cairo, Cairo, Egypt.
Department of Molecular Biology and Biochemistry, University of Cairo, Cairo, Egypt.
J Interv Cardiol. 2016 Feb;29(1):89-98. doi: 10.1111/joic.12269.
Endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) are mobilized from the bone marrow and increase in the early phase after ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the prognostic significance of CECs and indices of endothelial dysfunction in patients with STEMI. In 78 patients with acute STEMI, characterization of CD34+/VEGFR2+CECs, and indices of endothelial damage/dysfunction such as brachial artery flow mediated dilatation (FMD) were determined. Blood samples for CECs assessment and quantification were obtained within 24 hours of admission and FMD was assessed during the index hospitalization. At 30 days follow up, the primary composite end point of major adverse cardiac events (MACE) consisting of all-cause mortality, recurrent nonfatal MI, or heart failure and the secondary endpoint of early adverse left ventricular (LV) remodeling were analyzed. The 17 patients (22%) who developed MACE had significantly higher CEC level (P = 0.004), von Willebrand factor (vWF) level (P = 0.028), and significantly lower FMD (P = 0.006) compared to the remaining patients. Logistic regression analysis showed that CECs level and LV ejection fraction were independent predictors of MACE. The areas under the receiver operating characteristic curves (ROC) for CEC level, FMD, and the logistic model with both markers were 0.73, 0.75, and 0.82, respectively, for prediction of the MACE. The 16 patients who developed the secondary endpoint had significantly higher CEC level compared to remaining patients (P = 0.038). In conclusion, increased circulating endothelial cells and endothelial dysfunction predicted the occurrence of major adverse cardiac events and adverse cardiac remodeling in patients with STEMI.
内皮祖细胞（EPCs）和循环内皮细胞（CECs）从骨髓中动员出来，并在ST段抬高型心肌梗死（STEMI）后的早期阶段增加。本研究的目的是评估STEMI患者中CECs的预后意义以及内皮功能障碍指标。在78例急性STEMI患者中，对CD34+/VEGFR2+CECs进行了特征分析，并测定了内皮损伤/功能障碍指标，如肱动脉血流介导的扩张（FMD）。在入院后24小时内采集用于CECs评估和定量的血样，并在本次住院期间评估FMD。在30天随访时，分析了由全因死亡率、复发性非致命性心肌梗死或心力衰竭组成的主要不良心脏事件（MACE）的主要复合终点以及早期不良左心室（LV）重构的次要终点。与其余患者相比，发生MACE的17例患者（22%）的CEC水平显著更高（P = 0.004）、血管性血友病因子（vWF）水平显著更高（P = 0.028），而FMD显著更低（P = 0.006）。逻辑回归分析表明，CECs水平和左心室射血分数是MACE的独立预测因素。CEC水平、FMD以及包含这两个标志物的逻辑模型的受试者工作特征曲线（ROC）下面积分别为0.73、0.75和0.82，用于预测MACE。与其余患者相比，发生次要终点的16例患者的CEC水平显著更高（P = 0.038）。总之，循环内皮细胞增加和内皮功能障碍可预测STEMI患者发生主要不良心脏事件和不良心脏重构。
