Key result
Lower circulating CD34+CD133+ progenitor cell levels linked to bioprosthetic valve deterioration.
Why the study?
Mechanisms underlying bioprosthetic valve deterioration are incompletely elucidated, and the role of circulating progenitor cell subpopulations remains elusive.
Are circulating progenitor cell levels associated with hemodynamic valve deterioration in patients undergoing bioprosthetic aortic valve replacement?
Cohort (n=121)
No
Are circulating progenitor cell levels associated with hemodynamic valve deterioration in patients undergoing bioprosthetic aortic valve replacement?
Hazard Ratio: 0.995 (95% CI 0.99–0.999)
p-value: p=0.020
Lower levels of reparative CD34+CD133+ cells and higher levels of osteocalcin-positive cells are associated with bioprosthetic aortic valve deterioration.
May flag higher-risk patients for closer post-AVR surveillance; leaves open whether progenitor cell assessment should guide monitoring or trials.
Background Mechanisms underlying bioprosthetic valve deterioration are multifactorial and incompletely elucidated. Reparative circulating progenitor cells, and conversely calcification‐associated osteocalcin expressing circulating progenitor cells, have been linked to native aortic valve deterioration. However, their role in bioprosthetic valve deterioration remains elusive. This study sought to evaluate the contribution of different subpopulations of circulating progenitor cells in bioprosthetic valve deterioration. Methods and Results This single‐center prospective study enrolled 121 patients who had peripheral blood mononuclear cells isolated before bioprosthetic aortic valve replacement and had an echocardiographic follow‐up ≥2 years after the procedure. Using flow cytometry, fresh peripheral blood mononuclear cells were analyzed for the surface markers CD34, CD133, and osteocalcin. Bioprosthetic valve deterioration was evaluated by hemodynamic valve deterioration (HVD) using echocardiography, which was defined as an elevated mean transprosthetic gradient ≥30 mm Hg or at least moderate intraprosthetic regurgitation. Sixteen patients (13.2%) developed HVD during follow‐up for a median of 5.9 years. Patients with HVD showed significantly lower levels of reparative CD34 + CD133 + cells and higher levels of osteocalcin‐positive cells than those without HVD (CD34 + CD133 + cells: 125 [80, 210] versus 270 [130, 420], P =0.002; osteocalcin‐positive cells: 3060 [523, 5528] versus 670 [180, 1930], P =0.005 respectively). Decreased level of CD34 + CD133 + cells was a significant predictor of HVD (hazard ratio, 0.995 [95% CI, 0.990%–0.999%]). Conclusions Circulating levels of CD34 + CD133 + cells and osteocalcin‐positive cells were significantly associated with the subsequent occurrence of HVD in patients undergoing bioprosthetic aortic valve replacement. Circulating progenitor cells might play a vital role in the mechanism, risk stratification, and a potential therapeutic target for patients with bioprosthetic valve deterioration.
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Kanaji et al. (2023) conducted a cohort in Bioprosthetic aortic valve deterioration (n=121). Decreased circulating CD34+CD133+ progenitor cells vs. Higher circulating CD34+CD133+ progenitor cells was evaluated on Hemodynamic valve deterioration (HR 0.995, 95% CI 0.990-0.999, p=0.020). Decreased levels of circulating CD34+CD133+ progenitor cells prior to bioprosthetic aortic valve replacement were significantly associated with subsequent hemodynamic valve deterioration (HR 0.995).
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