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Published on: April 27, 2016
The effects of exercise stress testing on soluble E-selectin, von Willebrand factor, and circulating endothelial
Christopher J Boos1, Balu Balakrishnan, Gregory Y H Lip
1Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
Insights
Exercise stress testing significantly increased circulating endothelial cells (CECs), von Willebrand factor (vWF), and soluble E-selectin (sEsel). CECs correlated with other endothelial markers but did not predict exercise capacity or test results in patients with suspected coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Endothelial Function
Background:
- Circulating endothelial cells (CECs) quantify endothelial damage and correlate with coronary artery disease (CAD) severity.
- Endothelial dysfunction markers are crucial in assessing cardiovascular health.
Purpose of the Study:
- To evaluate the relationship between CECs and other endothelial dysfunction markers (vWF, sEsel) during exercise stress testing (EST).
- To assess the predictive value of CECs in patients with suspected CAD undergoing EST.
Main Methods:
- A cohort of 31 patients with suspected CAD underwent treadmill EST.
- Blood samples for CECs, vWF, and sEsel were collected pre-exercise, immediately post-exercise, and 30 minutes post-EST.
- CEC quantification used an immunobead method; vWF and sEsel were measured by ELISA.
Main Results:
- EST significantly increased CECs, sEsel, and vWF levels compared to baseline.
- A significant correlation was observed between changes in CECs and changes in vWF and sEsel.
- Neither absolute nor delta CEC counts predicted exercise workload, functional capacity, or positive EST results.
Conclusions:
- EST induces a significant rise in endothelial markers, including CECs.
- The increase in CECs during EST is associated with other endothelial markers but does not predict exercise performance or diagnostic outcomes in suspected CAD.
Background:
The quantification of circulating endothelial cells (CECs) in whole blood is an increasingly recognized index of endothelial damage/dysfunction. Abnormal CECs have been linked to the severity of coronary artery disease (CAD).
Objective:
We assessed the relationship of CECs to other markers of endothelial dysfunction (von Willebrand factor (vWF) and soluble E-selectin (sEsel)) during exercise stress testing (EST) in a cohort of patients with suspected CAD.
Methods:
We studied a cohort of patients referred to our chest pain clinic with a history of exertional chest pain. Treadmill EST was performed, using a full Bruce exercise protocol. Blood for CECs (immunobead method), vWF and sEsel (both ELISA) were collected immediately before (pre-exercise), immediately following exercise, and at 30 minutes post-EST.
Results:
We studied 31 patients (84% male; mean (SD) age 58.4 (9.8) years). Of the entire cohort, 14 patients (45.2%) had a positive EST. Exercise led to significant increases in levels of CECs, sEsel, vWF, white blood cells (WBC), heart rate, mean and systolic blood pressure compared with base-line (all P < 0.05). There was a significant correlation between the change (delta (immediate post-pre-exercise)) in CECs and delta vWF (r = 0.45; 95% CI 0.11-0.69: P = 0.01) and delta sEsel (r = 0.41; 0.05-0.7: P = 0.02), as well as between delta vWF and delta sEsel (r = 0.55; 0.25-0.76: P = 0.001). Neither absolute nor delta CEC counts were predictive of exercise work-load/functional capacity, nor the presence of positive EST results.
Conclusion:
EST led to a significant increase in endothelial markers (CECs, vWF, and sEsel) compared with base-line levels. The rise in CECs correlated with the increases in other endothelial markers, but was not related to the either exercise workload/capacity or to the presence of a positive EST.
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