Adherence to lifestyles modifications after a Cardiac Rehabilitation program (CR) and Endothelial Progenitor Cells (EPCs): a 6-months follow-up study

Abstract Background Chronic heart failure (CHF) remains a leading cause of morbidity and mortality and it is characterized by vascular endothelial dysfunction. During the last decades, endothelial progenitor cells (EPCs) are being used as an index of the endothelium restoration potential, therefore reflecting the vascular endothelial function. Exercise training has been shown to stimulate the mobilization of EPCs at rest in CHF patients. However, the effect of exercise training on the acute respond of EPCs after maximum exercise in CHF patients remains unknown. Purpose The purpose of the study was to assess the effect of a cardiac rehabilitation (CR) program on the acute respond of EPCs after maximum exercise in patients with CHF. Methods Forty-four consecutive patients (35 males) with stable CHF [mean±SD, Age (years): 56±10, BMI (kg/m2): 28.7±5.2, EF (%): 33±8, Peak VO2 (ml/kg/min): 18.4±4.4, Peak work rate (watts): 101±39] enrolled a 36-session CR program based on high-intensity interval exercise training. All patients underwent an initial symptom limited maximal cardiopulmonary exercise testing (CPET) on an ergometer before the CR program and a final maximal CPET after the CR program. Venous blood was drawn before and after each CPET. Five circulating endothelial populations were identified and quantified by flow cytometry; CD34+/CD45-/CD133+, CD34+/CD45-/CD133+/VEGFR2, CD34+/CD133+/VEGFR2, CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2. EPCs values are expressed as cells/million enucleated cells in medians (25th-75th percentiles). Results The acute mobilization of EPCs after the final CPET was higher than after the initial CPET in 4 out of 5 circulating endothelial populations. Most specifically, difference of the acute mobilization of CD34+/CD45-/CD133+ cells [initial CPET: 25 (15–46) vs final CPET: 49 (26–71), p=0.002], CD34+/CD45-/CD133+/VEGFR2 cells [initial CPET: 3 (2–5) vs final CPET: 8 (5–12), p<0.001], CD34+/CD45-/CD133- cells [initial CPET: 129 (52–338) vs final CPET: 250 (129–518), p=0.03] and CD34+/CD45-/CD133-/VEGFR2 cells [initial CPET: 2 (1–4) vs final CPET: 6 (3–9), p<0.001] increased after the final CPET. The acute mobilization of CD34+/CD133+/VEGFR2 cells [initial CPET: 3 (−1–7) vs final CPET: 5 (0–15), p=0.441] did not differ between the 2 CPETS. Conclusion A 36-session cardiac rehabilitation program increases the acute respond of endothelial progenitor cells after maximum cardiopulmonary exercise training in patients with chronic heart failure, therefore indicating the beneficial effect of exercise training on the vascular endothelial function. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): Co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme “Human Resources Development, Education and Lifelong Learning” in the context of the project

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Understanding and Practice: A 7-Year Follow-Up Study on Implementation of a Cardiac Rehabilitation Program

Qualitative Health Research ◽

10.1177/104973202129120179 ◽

2002 ◽

Vol 12 (5) ◽

pp. 671-684 ◽

Cited By ~ 8

Author(s):

Eva Henriksen ◽

Urban Rosenqvist

Keyword(s):

Cardiac Rehabilitation ◽

Rehabilitation Program ◽

Cardiac Rehabilitation Program ◽

Follow Up Study

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Endothelial Progenitor Cells and Cardiovascular Events in Patients with Chronic Kidney Disease – a Prospective Follow-Up Study

PLoS ONE ◽

10.1371/journal.pone.0011477 ◽

2010 ◽

Vol 5 (7) ◽

pp. e11477 ◽

Cited By ~ 25

Author(s):

Johan Lorenzen ◽

Sascha David ◽

Ferdinand H. Bahlmann ◽

Kirsten de Groot ◽

Elisabeth Bahlmann ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Cardiovascular Events ◽

Endothelial Progenitor ◽

Follow Up Study

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Autologous Endothelial Progenitor Cells Transplantation for Acute Ischemic Stroke: A 4-Year Follow-Up Study

Stem Cells Translational Medicine ◽

10.1002/sctm.18-0012 ◽

2018 ◽

Vol 8 (1) ◽

pp. 14-21 ◽

Cited By ~ 20

Author(s):

Jie Fang ◽

Yang Guo ◽

Sheng Tan ◽

Zhanhui Li ◽

Huifang Xie ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Endothelial Progenitor ◽

Follow Up Study

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Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells

Thrombosis and Haemostasis ◽

10.1160/th13-10-0869 ◽

2014 ◽

Vol 112 (07) ◽

pp. 196-204 ◽

Cited By ~ 5

Author(s):

Rossella Marcucci ◽

Anna Gori ◽

Costanza Burgisser ◽

Sara Francini ◽

Anna Roberts ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Exercise Capacity ◽

Dietary Habits ◽

Rehabilitation Program ◽

Lifestyle Modifications ◽

Endothelial Progenitor ◽

Lifestyle Recommendations ◽

The Impact

SummaryAn increase of endothelial progenitor cells (EPCs) among acute myo-cardial infarction (AMI) patients participating in a cardiac rehabilitation (CR) program has been reported, but no data on the impact of adherence to lifestyle recommendations provided during a CR program on EPCs are available. It was our aim to investigate the effect of adherence to lifestyle recommendations on EPCs, inflammatory and functional parameters after six months of a CR program in AMI patients. In 110 AMI patients (90 male/20 female; mean age 57.9 ± 9.4 years) EPCs, high sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels, and cardiopulmonary testings were determined at the end of the CR (T1) and at a six-month follow-up (T2). At T2 we administered a questionnaire assessing dietary habits and physical activity. At T2, we observed a decrease of EPCs (p<0.05), of hsCRP (p=0.009) and of NT-ProBNP (p<0.0001). Patient population was divided into three categories by Healthy Lifestyle (HL) score (none/low, moderate and high adherence to lifestyle recommendations). We observed a significant association between adherence to lifestyle recommendations, increase in EPCs and exercise capacity between T1 and T2 (Δ EPCs p for trend <0.05; ΔWatt max p for trend=0.004). In a multivariate logistic regression analyses, being in the highest tertile of HL score affected the likelihood of an increase of EPC levels at T2 [OR (95% confidence interval): 3.36 (1.0–10.72) p=0.04]. In conclusion, adherence to lifestyle recommendations provided during a CR program positively influences EPC levels and exercise capacity.

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The Beneficial Effects of Cardiac Rehabilitation on the Function and Levels of Endothelial Progenitor Cells

Heart Lung and Circulation ◽

10.1016/j.hlc.2016.06.1210 ◽

2017 ◽

Vol 26 (1) ◽

pp. 10-17 ◽

Cited By ~ 8

Author(s):

Yuan Guo ◽

Robert Andre Ledesma ◽

Ran Peng ◽

Qiong Liu ◽

Danyan Xu

Keyword(s):

Cardiac Rehabilitation ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Endothelial Progenitor ◽

Beneficial Effects

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Abstract 5998: Final Results of the HEALING 2B Trial to Evaluate a Bioengineered CD34 Antibody Coated Stent (Genous ™ Stent) Designed to Promote Vascular Healing by Capture of Circulating Endothelial Progenitor Cells in CAD Patients

Circulation ◽

10.1161/circ.118.suppl_18.s_1042-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

H Duckers ◽

Yoshinobu Onuma ◽

Edouard Benit ◽

Robert J de Winter ◽

William Wijns ◽

...

Keyword(s):

Coronary Artery ◽

Statin Therapy ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Stent Thrombosis ◽

De Novo ◽

Endothelial Progenitor ◽

Circulating Endothelial Progenitor Cells ◽

Late Luminal Loss

Background: In contrast to a cytotoxic or cytostatic pharmacotherapy, promoting the vascular healing response by capturing and sequestering circulating endothelial progenitor cells (EPC) to the stent surface by a CD34 antibody coating (Genous ™ stent) may accelerate stent reendo-thelialization and prevent restenosis formation, as well as stent thrombosis (ST) Methods: The HEALING IIB study was a multi-center, prospective trial designed to assess the safety and efficacy of the Genous ™ bio-engineered stent in conjunction with HmG CoA reductase inhibitors (statins) to stimulate EPC recruitment, in the treatment of patients with de novo coronary artery lesions (n=100 pts). The primary safety endpoint was major adverse cardiac events (MACE) at 30 days, whereas the primary efficacy endpoint was late luminal loss by QCA at 6 months follow-up. Results: At interim analysis of the first 45 patients that completed the 6-month angiographic follow-up, the composite MACE rate was 11.1%, whereas 6.6% clinically justified target lesion revascularizations were observed. 2 Patients died within the first 30 days after stent implantation due to angiographically verified stent thrombosis. Low circulating EPC titers were previously associated with a poor response to the EPC capture stent with TLR events and high late loss. Therefore, patients were pre-treated with Atorvastatin 80 mg qd prior to the PCI in order to augment EPC levels. Statin therapy stimulated the levels of committed EPCs by +294%, but failed to increase the titer of CD34+cells (+25%). Although statin pretreatment stimulated EPC levels, the angiographic outcome of the EPC capture stent was not improved in these patients: in-stent late luminal loss was 0.77±0.46 mm. We anticipate to complete analysis of the 6 month angiographic follow-up of all 100 patients by the time of the AHA2008. Conclusions: The HEALING-IIB study suggests that the EPC capture coronary stent in combination with statin therapy does not sufficiently impede stent restenosis formation for the treatment of de novo coronary artery disease. Although concomitant statin therapy was able to stimulate EPC recruitment, it failed to stimulate CD34+ stem cell levels and did not improve the angiographic outcome of the bioengineered EPC capture stent.

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