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

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

doi:10.1155/2010/212509

Andrzej Surdacki, Jacek S Dubiel + Show 5 more

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https://doi.org/10.1155/2010/212509

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Journal: Disease markers	Publication Date: Jan 1, 2010
Citations: 2	License type: CC BY 3.0

Affiliation: Jagiellonian University

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.

Highlights

Elevated circulating levels of B-type natriuretic peptide (BNP) or N-terminal fragment of its prohormone (NT-proBNP) are adverse outcome predictors in heart failure and acute coronary syndromes and102 A
The prognostic effect of BNP/NT-proBNP in stable coronary artery disease (CAD) was maintained after multivariate adjustment including ejection fraction (EF), angiographic CAD extent, renal function, left ventricular (LV) end-diastolic pressure (LVEDP) and echocardiographic categories of diastolic dysfunction [1,2,3,4,5,6], which suggests that the effect extends into low-risk subjects with discrete or absent LV function abnormalities
The CAD group was formed by 30 men who fulfilled all four of the following inclusion criteria: stable angina class III according to the Canadian Cardiovascular Society (CCS) classification, angiographically significant onevessel CAD, classical ECG signs of subendocardial myocardial ischemia during an exercise test [27], and an unchanged therapy with a low-dose aspirin, statin and angiotensin-converting enzyme inhibitor (ACEI) for 3 preceding months

Summary

Introduction

Elevated circulating levels of B-type natriuretic peptide (BNP) or N-terminal fragment of its prohormone (NT-proBNP) are adverse outcome predictors in heart failure and acute coronary syndromes and102 A. Elevated circulating levels of B-type natriuretic peptide (BNP) or N-terminal fragment of its prohormone (NT-proBNP) are adverse outcome predictors in heart failure and acute coronary syndromes and. The prognostic effect of BNP/NT-proBNP in stable CAD was maintained after multivariate adjustment including ejection fraction (EF), angiographic CAD extent, renal function, left ventricular (LV) end-diastolic pressure (LVEDP) and echocardiographic categories of diastolic dysfunction [1,2,3,4,5,6], which suggests that the effect extends into low-risk subjects with discrete or absent LV function abnormalities. In patients with preserved EF moderate elevations of B-type natriuretic peptides were described in parallel to the degree of LV diastolic dysfunction with about 6-fold and 3-fold increases in BNP and NTproBNP, respectively, in the earliest phase of diastolic abnormalities, equivalent to impaired LV relaxation [8, 10]. BNP gene is overexpressed in the hypoxic myocardium [11]

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