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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
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32. Cardiovascular Nursing
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Circulating EPC levels in ischemic and non-ischemic heart failure: why benefit from CRT differs
Session:
CO - Prémio Jovem Investigador (Investigação Básica)
Speaker:
James Milner
Congress:
CPC 2019
Topic:
O. Basic Science
Theme:
36. Basic Science
Subtheme:
36.3 Basic Science - Cardiac Diseases
Session Type:
Comunicações Orais
FP Number:
---
Authors:
James Milner; Natália António; Gonçalo Cristóvão; Patrícia M. Alves; Ana Vera Marinho; Célia Domingues; Miguel Ventura; João Cristóvão; Luis Elvas; Artur Paiva; Lino Gonçalves
Abstract
<p><strong>Background: </strong>Endothelial Progenitor Cells (EPCs) are multipotent adult stem cells that circulate in the peripheral blood, playing an important role in postnatal neovascularization and repair of ischemic cardiac injury. However, levels of circulating EPCs are reduced in coronary artery disease (CAD) and correlate inversely with the severity of CAD. As such, EPC levels would be expected to be reduced in ischemic cardiomyopathy (ICM), yet little is known about EPCs in patients with chronic heart failure (HF). We sought to evaluate the relationship between the underlying HF etiology and circulating EPC levels.</p> <p><strong>Population and methods: </strong>Prospective, single-center study of 50 patients with advanced HF submitted to cardiac resynchronization therapy (CRT), including 11 patients with ischemic cardiomyopathy (ICM) and 39 with non-ischemic dilated cardiomyopathy (DCM). Two populations of circulating EPCs were evaluated by flow cytometry previously to CRT implantation: CD34+KDR+ and CD133+KDR+ cells. Response to CRT was defined as a reduction in left ventricular end-systolic volume of ≥15% at 6-months follow up. The mean follow-up was 5.4±2.3 years.</p> <p><strong>Results: </strong>Compared with patients with DCM, patients with ICM were more frequently male (100 vs 54%, p=0.005) and exhibited more cardiovascular risk factors. There were no significant differences in age, QRS duration, left ventricular ejection fraction or volumes between the 2 groups. Regarding remodeling response to CRT, patients with ICM tended to present a lower proportion of responders than patients with DCM (36.4% vs 64.1%, p=0.098, respectively). During follow-up, there were no significant differences in the mortality rate or heart transplantation rate between groups (36.4% in ICM vs 35.9% in DCM, p=0.977 and 9.1% vs 2.6%, p=0.329, respectively). However, patients with ICM tended to be more often hospitalized due to HF than DCM patients (mean number of hospitalizations: 1.8±2.0 vs 0.8±1.3, p=0.052, respectively and hospitalization rate: 63.6% vs 38.5%, p=0.137, respectively). Patients with ICM showed significantly lower levels of circulating EPCs when compared to their counterparts, which was observed for both the CD34+KDR+ (32.7±31.6 vs 9.9±6.8 cells/1 000 000 leukocytes, p<0.001) and the CD133+KDR+ (11.4± 9.5 vs 4.3±4.7 cells/1 000 000 leukocytes, p=0.007).</p> <p><strong>Conclusions:</strong> This study shows that in chronic HF, patients with an ischemic etiology exhibit significantly lower levels of circulating EPCs than their non-ischemic counterparts, reflecting a poorer endogenous regenerative capacity. This EPC pauperization may hinder the left ventricular reverse remodeling process, necessary for response to CRT, and may justify why ICM patients typically benefit less from CRT.</p>
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