Coincidence of moderately elevated N-terminal pro–B-type natriuretic peptide, endothelial progenitor cells deficiency and propensity to exercise-induced myocardial ischemia in stable angina

Article type: Research Article

Authors: Surdacki, Andrzej | Marewicz, Ewa | Rakowski, Tomasz | Szumańska, Monika | Szastak, Grzegorz | Pryjma, Juliusz | Dubiel, Jacek S.

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: [email protected]

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.

Keywords: B-type natriuretic peptide, endothelial progenitor cells, coronary artery disease, left ventricular diastolic dysfunction, myocardial ischemia

DOI: 10.3233/DMA-2010-0690

Journal: Disease Markers, vol. 28, no. 2, pp. 101-114, 2010