Levels of Circulating Pro-angiogenic Cells Predict Cardiovascular Outcomes in Patients With Chronic Heart Failure

Background: Circulating pro-angiogenic cells (PACs) contribute to vascular and myocardial regeneration. A low level of PACs is associated with worse outcome in patients with coronary heart disease. However, little is known about PACs in heart failure (HF). Methods and Results: Blood was sampled at baseline in 111 patients with HF, 67 from 5 Italian Centers and 44 from Frankfurt, Germany. In Cultured mononuclear cells from peripheral blood, PACs were counted as double-stained by tetramethylindocarbocyanine-labeled acetylated LDL and fluorescein-5-isothiocyanate-labeled lectin. Mean age of the patients was 62 years, 12 were females, 66 had ischemic etiology, 26 were in New York Heart Association Class >II. Cutoffs for PACs were assessed by receiver operating characteristic curves, to identify the optimal cutoffs for PAC level in predicting Outcomes. Mean level of PACs was 35 29 (mean +/- SD) cells/mm(2), 2- to 3-fold lower than in age-matched healthy Volunteers, but unrelated to severity of HE a-e.. or sex. Over 2.5 years, 12 cardiovascular deaths and 47 first hospitalizations for cardiovascular reasons were recorded. After adjustment for demographic and clinical variables, elevated creatinine and natriuretic peptides. and PACs <= 30.5/mm(2) were associated with a 2-fold higher risk of cardiovascular death and hospitalization, as shown by Survival Curves and by Cox multivariable. Conclusions: The level of circulating PACs is an independent predictor of cardiovascular death and hospitalization in patients with chronic HE it can be assessed in blood samples collected in a multicenter setting, and may offer an accessible tool to assess the role of vascular regeneration in patients with HE (J Cardiac Fail 2009;15:747-755)