Predictive value of circulating apoptotic microparticles in patients with ischemic symptomatic moderate-to-severe chronic heart failure
Резюме. 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 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/mL (95% confidence interval [CI]=0.271–0.309/mL) and 0.673/mL (95% CI=0.65–0.74/mL) (P<0.001). Number of circulating MPs was distributed into Quartiles (Q): Q1 (<0.341/mL), Q2 (0.342–0.514/mL), Q3 (0.521–0.848/mL), and Q4 (>0.850/mL). Receive Operation Curve (ROC) analysis has been shown that cut off point of CD31+/annexin V+ MPs number for cumulative survival function was 0.514/mL. Area under curve was 0.913 (Standard 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/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.