Abstract
BackgroundEndothelial progenitor cells (EPC) are involved in neovascularization and endothelial integrity. They might be protective in atherosclerosis. Optical coherence tomography (OCT) is a precise intracoronary imaging modality that allows assessment of subintimal plaque development. We evaluated the influence of EPC on coronary plaque burden in stable disease and implemented a novel computational plaque analysis algorithm using OCT.MethodsForty-three patients (69.8% males, 69.6 ± 7.7 years) were investigated by OCT during re-angiography 6 months after elective stent implantation. Different subpopulations of EPCs were identified by flow cytometry according to their co-expression of antigens (CD34+, CD133+, kinase domain receptor, KDR+). An algorithm was applied to calculate the underlying total plaque burden of the stented segments from OCT images. Plaque morphology was assessed according to international consensus in OCT imaging.ResultsA cumulative sub-strut plaque volume of 10.87 ± 12.7 mm3 and a sub-stent plaque area of 16.23 ± 17.0 mm2 were found within the stented vessel segments with no significant differences between different stent types. All EPC subpopulations (mean of EPC levels: CD34+/CD133+: 2.66 ± 2.0%; CD34+/KDR+: 7.50 ± 5.0%; CD34+/CD133+/KDR+: 1.12 ± 1.0%) inversely correlated with the identified underlying total plaque volume and plaque area (p ≤ 0.012).ConclusionsThis novel analysis algorithm allows for the first time comprehensive quantification of coronary plaque burden by OCT and illustration as spread out vessel charts. Increased EPC levels are associated with less sub-stent coronary plaque burden which adds to previous findings of their protective role in atherosclerosis.
Highlights
Endothelial progenitor cells (EPC) are involved in neovascularization and endothelial integrity
EPC were identified by flow cytometry according to their surface antigens CD34, CD133 and Kinase domain receptor (KDR) as described before [9, 25]
Study population and procedural characteristics In this sub-study of the OCTOPUS trial 44 lesions in 43 patients were investigated with Optical coherence tomography (OCT) during reangiography 6 months after elective coronary stenting
Summary
Endothelial progenitor cells (EPC) are involved in neovascularization and endothelial integrity. EPC are pluripotent, mononuclear cells deriving from bone marrow. They are found to be involved in new vessel formation and vascular regeneration after arterial injury [1,2,3,4]. There is growing evidence that some EPC subpopulations, characterized by surface markers like CD34, CD133 or KDR, might exert protective properties in atherosclerosis [5,6,7,8]. Common cardiovascular risk factors like smoking, obesity, hypercholesterolemia, diabetes, inactivity or chronic inflammation are associated with reduced numbers and impaired function of EPC [9,10,11,12]. ACE inhibitors, omega-3 fatty acids, estrogens and highdensity lipoprotein among others have been correlated with increased EPC levels [13, 14]
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