Circulating Progenitor Cells and Coronary Collaterals in Chronic Total Occlusion
Daniel A Gold1, Pratik B Sandesara1, Bryan Kindya1
1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
Higher circulating progenitor cell (CPC) counts in patients with coronary artery chronic total occlusions (CTO) are linked to better collateral development and reduced ischemic burden. This suggests CPCs play a key role in managing CTO.
Area of Science:
- Cardiovascular Medicine
- Regenerative Medicine
- Hematology
Background:
- The role of circulating progenitor cells (CPCs) in coronary artery chronic total occlusion (CTO) collateralization remains unclear.
- Investigating CPC levels' association with collateral development and ischemic burden in stable CTO patients.
Purpose of the Study:
- To determine if higher circulating progenitor cell (CPC) counts correlate with enhanced collateral artery formation in patients with coronary chronic total occlusions (CTOs).
- To assess the relationship between CPC levels and the degree of ischemic burden, indicated by high-sensitivity troponin-I (hsTn-I), in CTO patients.
Main Methods:
- Enumeration of CPCs using flow cytometry, identifying CD45med+ mononuclear cells expressing CD34 and CD34/CD133 epitopes.
- Multivariate regression analysis to evaluate the association between CPC counts, Rentrop collateral grade, and hsTn-I levels, adjusting for clinical factors.
Main Results:
- Higher CPC counts (CD34+ and CD34+/CD133+) were positively associated with greater Rentrop collateral grade (P=0.082 and P=0.028, respectively).
- Each doubling of CPC counts correlated with significantly lower hsTn-I levels (P=0.002 for CD34+ and P=0.009 for CD34+/CD133+).
Conclusions:
- Elevated circulating progenitor cell (CPC) levels are associated with improved collateral development in coronary artery chronic total occlusions (CTOs).
- Higher CPC counts indicate a lower ischemic burden in patients presenting with CTOs.
Background:
The role of circulating progenitor cells (CPC) in collateral formation that occurs in the presence of chronic total occlusions (CTO) of a coronary artery is not well established. In stable patients with a CTO, we investigated whether CPC levels are associated with (a) collateral development and (b) ischemic burden, as measured by circulating high sensitivity troponin-I (hsTn-I) levels.
Methods:
CPCs were enumerated by flow cytometry as CD45med+ blood mononuclear cells expressing CD34 and both CD34 and CD133 epitopes. The association between CPC counts and both Rentrop collateral grade (0, 1, 2, or 3) and hsTn-I levels were evaluated using multivariate regression analysis, after adjusting for demographic and clinical characteristics.
Results:
In 89 patients (age 65.5, 72% male, 27% Black), a higher CPC count was positively associated with a higher Rentrop collateral grade; [CD34+ adjusted odds ratio (OR) 1.49 95% confidence interval (CI) (0.95, 2.34) P = 0.082] and [CD34+/CD133+ OR 1.57 95% CI (1.05, 2.36) P = 0.028]. Every doubling of CPC counts was also associated with lower hsTn-I levels [CD34+ β -0.35 95% CI (-0.49, -0.15) P = 0.002] and [CD34+/CD133+ β -0.27 95% CI (-0.43, -0.08) P = 0.009] after adjustment.
Conclusion:
Individuals with higher CPC counts have greater collateral development and lower ischemic burden in the presence of a CTO.
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