Abstract
BackgroundEndothelial progenitor cells (EPCs) are implicated in protection against vascular disease. However, studies using angiography alone have reported conflicting results when relating EPCs to epicardial coronary artery disease (CAD) severity. Moreover, the relationship between different EPC types and the coronary microcirculation is unknown. We therefore investigated the relationship between EPC populations and coronary epicardial and microvascular disease.MethodsThirty-three patients with a spectrum of isolated left anterior descending artery disease were studied. The coronary epicardial and microcirculation were physiologically interrogated by measurement of fractional flow reserve (FFR), index of microvascular resistance (IMR) and coronary flow reserve (CFR). Two distinct EPC populations (early EPC and late outgrowth endothelial cells [OECs]) were isolated from these patients and studied ex vivo.ResultsThere was a significant inverse relationship between circulating OEC levels and epicardial CAD severity, as assessed by FFR and angiography (r = 0.371, p = 0.04; r = -0.358, p = 0.04; respectively). More severe epicardial CAD was associated with impaired OEC migration and tubulogenesis (r = 0.59, p = 0.005; r = 0.589, p = 0.004; respectively). Patients with significant epicardial CAD (FFR<0.75) had lower OEC levels and function compared to those without hemodynamically significant stenoses (p<0.05). In contrast, no such relationship was seen for early EPC number and function, nor was there a relationship between IMR and EPCs. There was a significant relationship between CFR and OEC function.ConclusionsEPC populations differ in regards to their associations with CAD severity. The number and function of OECs, but not early EPCs, correlated significantly with epicardial CAD severity. There was no relationship between EPCs and severity of coronary microvascular disease.
Highlights
Endothelial progenitor cells (EPCs) have been implicated in protection against vascular injury and atherogenesis [1]
Studies exploring the relationship between circulating EPC levels and angiographic severity of epicardial coronary artery disease (CAD) have yielded conflicting results [3,4]
There was a negative correlation between fractional flow reserve (FFR) and both left anterior descending artery (LAD) stenosis severity (r = -0.837, p,0.001) and Gensini score (r = -0.527, p = 0.001)
Summary
Endothelial progenitor cells (EPCs) have been implicated in protection against vascular injury and atherogenesis [1]. Animal experiments have reported that EPC transplantation prevents progression of atherosclerosis [2] Given their potential for cardiovascular regeneration and repair, studies have explored whether endogenous circulating EPC levels may be a marker of ‘‘vascular health’’. Studies exploring the relationship between circulating EPC levels and angiographic severity of epicardial coronary artery disease (CAD) have yielded conflicting results [3,4]. Endothelial progenitor cells (EPCs) are implicated in protection against vascular disease. Studies using angiography alone have reported conflicting results when relating EPCs to epicardial coronary artery disease (CAD) severity. We investigated the relationship between EPC populations and coronary epicardial and microvascular disease
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