Relationship between circulating endothelial cells and the predicted risk of cardiovascular events in acute coronary syndromes
Relationship between circulating endothelial cells and the predicted risk of cardiovascular events in acute coronary syndromes
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DOI：
10.1093/eurheartj/ehm070
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发表时间：
2007-05-01
影响因子：
39.3
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
--
作者：
Boos, Christopher J.;Soor, Simren K.;Lip, Gregory Y. H.
目的 全血中循环内皮细胞 (CEC) 的定量是直接内皮损伤的新标志物，并有望成为心血管 (CV) 风险的潜在生物标志物。尚未在大量“高风险”患者中探索 CEC 与预测心血管风险之间的相互关系。我们假设，在患有急性冠脉综合征 (ACS) 的广泛患者中，CEC 计数增加与预测的 CV 风险之间存在显着关系。 方法和结果 我们研究了 197 名确诊为不稳定型心绞痛 (UA)、非 ST 段抬高型心肌梗死 (MI、NSTEMI) 或 ST 段抬高入院的患者（年龄 40-80 岁） 心肌梗死（STEMI）。使用免疫珠技术对静脉全血进行 CEC 计数。根据初始临床病史和心电图以及入院 12 小时内收集的实验室参数值计算出四个经过充分验证的 ACS 风险评分 [（NSTEMI/UA 的 PURSUIT 和 TIMI）TIMI (STEMI) 和 GRACE（所有 ACS）]。我们纳入了健康对照（由 50 名匹配患者组成的 HQ 组，以量化 CEC 计数诊断 ACS 的准确性，并比较疾病与 HC 计数。与 HC 组相比，疾病组的 CEC 计数显着较高。随着疾病严重程度的增加，CEC 计数显着增加（即 UA 与 NSTEMI 与 STEMI；P = 0.002）。有心力衰竭临床证据的患者中 CEC 计数较高 (Kittip II-IV 级) 与入院时没有 (Kittip Class 1) 的患者相比 (P < 0.0001)。四种 ACS 风险评分方案的 CEC 计数与预测的 CV 风险之间存在显着相关性（所有 P < 0.05）。整个 ACS 队列的受试者工作特征 (ROC) 曲线 (AUC) 下面积为 0.82 (95% Cl: 0.76-0.88； P < 0.0001）。在存在适当的临床表现的情况下，CEC 计数 >= 7/mL 为 MI (NSTEMI/STEMI) 的诊断提供了 90.6% (95% Cl: 85.6-95.7%) 的阳性预测值 (95% Cl: 85.6-95.7%) 和 53.5% (41.9-65.1%) 的阴性预测值。 ACS 中的 CEC 和心血管风险增加。在这种情况下，CEC 的诊断准确性仅为“中等”。虽然它擅长确认 MI 的存在，但 CEC 值为
Aims The quantification of circulating endothelial cells (CECs) in whole blood is a novel marker of direct endothelial injury and shows promise as a potential biomarker of cardiovascular (CV) risk. The interrelationship(s) between CECs and predicted CV risk has not been explored in large cohort of 'highrisk' patients. We hypothesized that there would be a significant relationship between increasing CEC counts and predicted CV risk in a broad spectrum of patients presenting with acute coronary syndrome (ACS).Methods and results We studied 197 patients (aged 40-80 years) admitted with a confirmed diagnosis of unstable angina (UA), non-ST-elevation myocardial infarction (MI, NSTEMI), or ST-elevation MI (STEMI). CEC counts were performed on venous whole blood using the immunobead technique. Four well-validated ACS risk scores [(PURSUIT and TIMI for NSTEMI/UA) TIMI (STEMI) and GRACE (all ACS)] were calcutated from the initial clinical history and electrocardiogram, as well as from values of laboratory parameters collected within 12 h of admission. We included a healthy control (HQ group of 50 matched patients in order to quantify the accuracy of CEC counts for the diagnosis of ACS and to compare disease vs. HC counts. CEC counts were significantly higher in the disease group when compared with the HC group. CEC counts significantly increased with increasing severity of disease (that is, UA vs. NSTEMI vs. STEMI; P = 0.002). CEC counts were higher among patients with clinical evidence of heart failure (Kittip Class II-IV) when compared with those without (Kittip Class 1) on admission (P < 0.0001). There was a significant correlation between CEC counts and predicted CV risk for each of the four ACS risk scoring schemes (all P < 0.05). The area under the receiver- operating characteristic (ROC) curve (AUC) for the entire ACS cohort was 0.82 (95% Cl: 0.76-0.88; P < 0.0001). A CEC count of >= 7/mL provided a positive predictive value of 90.6% (95% Cl: 85.6-95.7%) and a negative predictive value of 53.5% (41.9-65.1%) for the diagnosis of MI (NSTEMI/STEMI) in the presence of an appropriate clinical presentation.Conclusion There is a significant and positive correlation between increasing CECs and increasing CV risk in ACS. The diagnostic accuracy of CECs in this setting is only 'moderate'. Whilst it is good at confirming the presence of MI, a CEC value of