Author + information
- Ronnie Ramadan,
- David Sheps,
- Ibhar Al Mheid,
- Malik Obideen,
- Fabio Esteves,
- J. Douglas Bremner,
- Viola Vaccarino and
- Arshed Quyyumi
Mental stress (MS) induced myocardial ischemia predicts frequent ambulatory ischemia and portends a worse prognosis in patients with coronary artery disease (CAD). Circulating bone marrow-derived progenitor cells (PC) participate in neoangiogenesis and are released in response to ischemia. We hypothesized that compared to patients without ischemia, those with MS ischemia will have differential PC counts and that MS will result in PC mobilization.
In 141 patients with documented CAD, 99mTc sestamibi myocardial perfusion imaging was used to detect MS ischemia induced by a standardized public speaking task. Using flow cytometry, circulating PC-enriched populations were estimated by the expression of CD34, CD133, CXCR4, and VEGF2R surface antigens on peripheral blood mononuclear cells (CD45medium) at baseline and 90 minutes after the MS task.
MS ischemia occurred in 22 (16%) patients. Patients with MS ischemia had higher circulating number of CXCR4-expressing cells at baseline; both CD34+/CXCR4+ (p=0.03) and triple positive CD34+/CD133+/CXCR4+ (p=0.01). Moreover, these counts were independent predictors for the development of MS ischemia after adjustment for age, sex, and established CV risk factors (p=0.02, and p=0.01, respectively). Thus, PC expressing CXCR4, denoting cells with a capacity to home to areas of ischemia, are increased in those who develop ischemia during MS. Furthermore, the MS challenge provoked a 21% increase in the number of circulating CD34+/VEGF2R+/CXCR4+ cells after 90 minutes (p=0.004). This increase was mainly in those without ischemia (P<0.001) as compared to those who developed ischemia during MS (p=0.3).
Patients who develop ischemia during MS have higher baseline circulating levels of PC that express CXCR4. This suggests that MS during daily living may stimulate PC mobilization. In addition, PC expressing both CXCR4 and VEGF2R increase during the MS challenge indicating that PC mobilize in response to stress. Whether the number of PC and their mobilization determine long term outcomes needs to be studied further.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Mental Stress on the Heart
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1108-62
- 2013 American College of Cardiology Foundation