Michowitz Y et al. (2007) Circulating endothelial progenitor cells and clinical outcome in patients with congestive heart failure. Heart 93: 1046–1050

Several studies have demonstrated a positive correlation between the level of circulating endothelial progenitor cells (EPCs) and the extent of tissue ischemia and endothelial damage. EPCs participate in vasculogenesis and angiogenesis, and a large pool of these cells might, therefore, reflect a high need for endothelial repair following damage. Researchers from the Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, conducted a study involving 107 consecutive patients in NYHA functional class II–IV and concluded that quantification of EPC levels might be useful in the clinical follow-up of patients with congestive heart failure (CHF).

The number of EPC colony-forming units isolated in 20 ml of peripheral blood was determined for each patient. Serum levels of vascular endothelial growth factor, N-terminal pro-brain natriuretic peptide and C-reactive protein were also quantified. Patients were followed up for a mean of 13.8 months, during which time 21 patients died and 26 were hospitalized for CHF. Cox regression analysis showed advanced age, diabetes mellitus and high levels of EPC colony-forming units to be independent predictors of all-cause mortality (P = 0.01, P = 0.002 and P = 0.02, respectively). EPC levels were not predictive of CHF-related hospitalization, possibly owing to the high level of mortality in this population. Further analyses demonstrated that EPC levels correlated with NYHA class, but not with the levels of vascular endothelial growth factor, N-terminal pro-brain natriuretic peptide or C-reactive protein.