血管学: オープンアクセス
オープンアクセス

概要

Predictive Value of Circulating Apoptotic Microparticles in Patients with Ischemic Symptomatic Moderate-To-Severe Chronic Heart Failure

Alexander E Berezin, Alexander A Kremzer, Tatayna A Samura and Yulia V Martovitskaya

Aim: To evaluate the prognostic value of circulating CD31+/annexin V+ Microparticles (MPs) for cumulative survival in patients with ischemic Chronic Heart Failure (CHF).

Methods: A total of 154 patients with ischemic symptomatic moderate-to-severe CHF were enrolled in the study on discharge from the hospital. Observation period was up to 3 years. Blood samples for biomarkers measurements were collected. Flow cytometry analysis for quantifying the number of CD31+/annexin V+ MPs was used. CD31+/ annexin V+ MPs number for cumulative survival cases due to CHF were tested. Additionally, all-cause mortality, and CHF-related death were examined.

Results: During a median follow-up of 2.18 years, 21 participants died and 106 subjects were hospitalized repetitively. Medians of circulating levels of CD31+/annexin V+ MPs in patients who survived and subjects who died were 0.286 n/mL (95% confidence interval [CI] = 0.271-0.309 n/mL) and 0.673 n/mL (95% CI = 0.65-0.74 n/ mL) (P<0.001). Number of circulating MPs was distributed into Quartiles (Q): Q1 (< 0.341 n/mL), Q2 (0.342-0.514 n/mL), Q3 (0.521-0.848 n/mL), and Q4 (> 0.850 n/mL). ROC analysis has been shown that cut off point of CD31+/ annexin V+ MPs number for cumulative survival function was 0.514 n/mL. Area under cure was 0.913 (Std. error = 0.025; 95% CI = 0.863-0.962), sensitivity and specificity were 89.6% and 69.7% respectively. It has been found a significantly divergence of Kaplan-Meier survival curves in patients with high quartile (MPs number >0.514 n/mL) of MPs numbers when compared with low quartiles. Using a stepwise model selection method for multivariable prediction model we investigated that CD31+/annexin V+ MPs number alone and combination of CD31+/annexin V+ MPs number with NT-pro-brain natriuretic peptide (NT-pro-BNP) remained statistically significant predictors for all-cause mortality, CHF-related death, and CHF-related re-hospitalisations, whereas combination of CD31+/annexin V+ MPs with both NT-pro-BNP and left ventricular ejection fraction did not.

Conclusion: Increased circulating CD31+/annexin V+ MPs associates with increased 3-year CHF-related death, all-cause mortality, and risk for recurrent hospitalization due to CHF.