Affiliations: Centro de Investigación, Hospital Universitario La
Fe, Valencia, Spain | Unidad de Insuficiencia Cardiaca y Transplante,
Servicio de Cardiología, Hospital Universitario La Fe, Valencia,
Spain | Servicio de Análisis Clínicos, Hospital
Universitario La Fe, Valencia, Spain | Department de Medicina de la Univesitat Autonoma de
Barcelona, Barcelona, Spain
Note: [] Corresponding author: Dr. V. Martínez-Sales, Centro de
Investigación, Hospital Universitario La Fe, Avda. Campanar 21,
46009-Valencia, Spain. Tel.: +34 96 386 2797; Fax: +34 96 197 3018; E-mail:
[email protected]
Abstract: Introduction and Aims: Acute and chronic heart failure may manifest
different degrees of endothelial damage and angiogenesis. Circulating
endothelial cells (CEC) have been identified as marker of vascular damage. The
aim of our study was to evaluate the evolution of the CEC at different stages
of patients with heart failure. We also investigated a potential correlation
between CEC and markers of vascular damage and angiogenesis. Methods: We studied 32 heart failure patients at hospital admission (acute phase) and at
revision after 3 months (stable phase) and 32 controls. Circulating markers of
endothelial damage (CEC; von Willebrand factor, vWF and soluble E-selectin,
sEsel) and angiogenesis (vascular endothelial growth factor, VEGF and
thrombospondin-1) were quantified. Results: Levels of CEC, vWF, sEsel and
VEGF are significantly higher in heart failure patients than in controls.
Levels of CEC (36.9 ± 15.3 vs. 21.5 ± 10.0 cells/ml; p< 0.001),
vWF (325 ± 101 vs. 231 ± 82%; p< 0.001) and VEGF (26.3 ±
15.2 vs. 21.9 ± 11.9 ng/ml; p< 0.001) are significantly higher in
the acute phase than in the stable phase of heart failure. CEC levels correlate
with vWF and VEGF. Results show than 100% of patients in acute phase and
37.5% in stable phase have levels of CEC higher than the 99th percentile of
the distribution of controls (16 cells/ml). Therefore, increases in CEC
represent a relative risk of 9.5 for heart failure patients suffering from
acute phase. Conclusions: CEC, in addition to being elevated in heart
failure, correlate with vWF levels, providing further support for CEC as
markers of endothelial damage. Levels of CEC are associated with the acute
phase of heart failure and could be used as a marker of the worsening in heart failure.
