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Circulating endothelial progenitor cells as predictors of long-term cardiovascular mortality after myocardial infarction: which definition should we use?
Session:
CO 04 - Doença coronária-genética-avaliação funcional
Speaker:
Diogo De Almeida Fernandes
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Diogo De Almeida Fernandes; Vânia Leal; Bárbara Oliveiros; Sónia Silva; Lino Gonçalves; Carlos Fontes Ribeiro; Natália António
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction:</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Endothelial progenitor cells (EPCs) are bone marrow-derived cells that play a crucial role in vascular repair after an acute myocardial infarction (AMI). Recent studies suggest that circulating EPCs levels may be useful as a surrogate biomarker for cardiovascular (CV) events. Nevertheless, the lack of a consensual definition and phenotypic characterization of EPCs hampers its use in clinical practice. CD34+KDR+, CD45dimCD34+KDR+ and CD34+CD133+KDR+ are among the most used antigenic phenotypes to define circulating EPCs but the best phenotype to predict CV outcomes remains to be determined. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objective:</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To determine the EPCs’ surface phenotype that best predicts long-term CV death after an AMI, and to evaluate its optimal cut-off point.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods:</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">One-hundred AMI patients were prospectively enrolled in the study. Circulating EPCs were quantified through high-performance flow cytometer within the first 24 hours of admission using different surface markers combinations allowing to simultaneously compare three EPCs definitions: 1) CD34+KDR+, 2) CD45dimCD34+KDR+, 3) CD34+CD133+KDR+. Mean follow-up time was 8.0 ± 2.2 years. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results:</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The mean age of our population was 59.7 ± 11.0, the majority of patients were male (90%), 65% had ST-elevation myocardial infarction (STEMI) and 35% non-ST segment elevation myocardial infarction (NSTEMI). Diabetes mellitus was present in 38% and hypertension in 67% of the studied sample. During the long-term follow-up, 34 patients had re-admissions due to cardiovascular causes, 11 of them for AMI. Thirty-one patients had major adverse cardiovascular events (MACE) and 19 died. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Using ROC curves, the CD34+KDR+ phenotype showed the biggest area under the curve regarding prediction of CV mortality (0.722; p = 0.010; confidence interval 95% (CI95%): 0.554 to 0.890). Patients with lower levels of EPCs according to this definition (≤ 0.022%) are 7 times more likely to die from CV causes at any time (hazard ratio = 7.55; p = 0.008; CI95% 1.69 to 33.83).</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion:</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The CD34+KDR+ phenotype appears to be the best definition of circulating EPCs for predicting long-term CV mortality after AMI. Further studies with larger samples are needed to clarify the optimal cut-off point for determining patients at risk and its role in everyday Cardiology</span></span></p>
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