1. High circulating IGF-1 and several cardiac stem cell (CSC) markers correlate with positive ventricular remodeling after revascularization.
2. High pre-op HGF and VEGF may protect damaged myocardium prior to revascularization.
Evidence Rating Level: 2 (Good)
Study Rundown: Long-term clinical outcomes of patients undergoing coronary artery bypass surgery are difficult to predict. Cardiac stem cells (CSCs) have for some time been implicated in cardiac remodeling, and there are a number of soluble factors known to affect their activity. The authors aimed to characterize the relationship among CSCs, circulating cytokines, and ventricular remodeling one year post-op in patients undergoing open coronary bypass. High circulating IGF-1 together with doubling time, IGF-1R expression, and telomerase in CSCs were found to predict ventricular remodeling. In addition, serum HGF and VEGF were significantly higher at baseline in the patients with positive remodeling. This study puts forth an interesting possibility for preoperative assessment of patients awaiting bypass surgery, though isn’t likely to affect surgical decision-making. However, it supports the development of stem cell therapeutic strategies and provides the foundation for a larger-scale evaluation of these biomarkers.
In-Depth [prospective cohort study]: The study enrolled 55 patients undergoing elective coronary artery bypass surgery, 17 of whom were lost at follow-up. The right atrial appendage was harvested for CSCs. At the time of surgery and at 12 +/- 1 months, patients had 2-D echocardiography, and labs for serum IGF-1, HGF, VEGF, SCF, G-CSF, and bFGF. CSCs were selected for with c-kit at P5 or P6 by FACS and telomere length as measured by flow-FISH with high telomerase activity. Indicators of CSC growth were correlated with improved echographic findings: decrease in chamber volume and increase in ventricular mass, mass-to-chamber volume ratio, and LV ejection fraction. Patients were then divided into two groups, based on an increase in LV end-diastolic volume of >= or < 20%. Positively-remodeled hearts were found to have shorter population doubling time, longer telomeres, and higher telomerase and IGF-1R activity. Multivariate analysis confirmed statistically significant association of CSC growth variables with LV remodeling.
By Mariya Samoylova and Allen Ho
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