Endocrine Abstracts

Background: Recent evidence has defined that circulating endothelial progenitor cells (EPCs) might have a pivotal role in the presence of atherosclerosis, chronically diseased vessels or following acute vascular injury. We hypothesized that diabetes mellitus (DM) may be related to worsening of ischemic chronic heart failure thereby suppression of mobilization of bone marrow-derived EPCs.

The aim of this study was to evaluate predict value of circulating EPCs in ischemic chronic heart failure patients with 2 type DM in long-term follow-up.

Methods: sixty eight moderate-to-severe ischemic chronic heart failure (CHF) subjects (36 with 2 type DM, left ventricular ejection fraction=42.68% (95% CI 36–51%) aged 46–62 years were enrolled to the study. Vessel-wall and plaque geometrical and compositional parameters were measured on contrast-enhanced CT angiography. Immunostaining and flow cytometric technique (FCT) were used for predicable distinguish cells subsets depended on expression of CD14, CD34, Tie-2, CD45, and VEGFR2. Circulating EPCs are defined accordingly ISHAGE criteria as CD34/VEGFR2 positive cells in absent CD45 expression. 100 000 events were analyzed from each tube at baseline of the study. Mononuclear cells were cultured for functional analysis (CFUs) after FCT. Standardized cell counts were presented as a percentage of total leukocytes, which were identified as the total number of all CD45+ cells. Observation period for the patients was 6 months.

Results: Analysis of obtained outcomes have been shown a significantly decreasing of the total CFU count and also circulating CD34+ subsets level: CD34+ CD45− VEGFR2+, and CD34+ CD45− Tei-2+ VEGFR2+ cells in CHF patients with 2 type DM when compared with subjects without one (P<0.001). Second type DM (HR=6.20, 95% CI 3.11–14.10, P=0.009), and lower CD34+ CD45− VEGFR2+ (HR=4.64, 95% CI 1.99–7.36, P=0.004) and lower CD34+ CD45− Tei-2+ VEGFR2+ (HR=0.58, 95% CI 3.15–12.10, P=0.007) were independent prognostic variables for cardiovascular outcomes (composite point included hospitalization rate, mortality rate, all cardiovascular events, worsening of CHF) within 6 months. Results did not change after adjustment for age, sex, BMI, smoke, hypercholesterolemia, arterial hypertension, NYHA functional class of CHF and previous myocardial infarction.

Conclusions: A lower of circulating EPCs defined as CD34+ CD45− VEGFR2+, and CD34+ CD45− Tei-2+ VEGFR2+ subsets cells in ischemic CHF patients with 2 type DM might have a high predict value for further cardiovascular outcomes. These findings can be taken into consideration as supporting of hypothesis about that such cellular biomarkers can reflect potential vascular repair insufficiency in diabetic patients with CHF.