The effects of exercise stress testing on soluble E‐selectin, von Willebrand factor, and circulating endothelial cells as indices of endothelial damage/dysfunction

Figures & data

Figure 1 Relationship of exercise to endothelial markers. A: Circulating endothelial cell (CEC) counts. B: Soluble E‐selectin (sEsel). C: von Willebrand Factor (vWF). (Pre = pre‐exercise; IP = immediate post; 30P = 30 minutes post‐exercise).

Table I. Base‐line characteristics of entire patient cohort.

Patient variable
n	31
Age	58.4 (9.8)
Males, n (%)	26 (83.9)
Body mass index	27.3 (3.6)
Ethnicity, n (%):
Caucasian	112(38.7)
Indo‐Asian	14 (45.2)
Afro‐Caribbean	4 (12.9)
Other	1 (3.2)
Smoking history, n (%):
Current smoker	9 (29)
Ex	3 (9.7)
Never	19 (61.3)
Serum creatinine (µmol/L)	85.7 (15.1)
Serum cholesterol (mmol/L)
Total	4.6 (1.3)
HDL	1.4 (0.4)
Risk factors, n (%):
MI	5 (16.1)
Diabetes mellitus	10 (32.30)
Hypertensive	18 (58.1)
Previous PCI	5 (16.1)
Medication, n (%):
Antiplatelet	20 (64.5)
Beta‐blocker	12 (38.7)
Calcium channel‐blocker	3 (9.7)
Oral nitrate	3 (9.7)
ACE inhibitor/ARB	14 (45.2)
Statin	15 (48.4)

MI = myocardial infarction; PCI = percutaneous coronary intervention (angioplasty ± stent); ARB = angiotensin II receptor‐blocker; HDL = high density lipoprotein; ACE = angiotensin‐converting enzyme.

Table II. The effects of exercise on blood and exercise‐related parameters.

Variable	Effects of exercise			P‐value
	Pre	Immediate post	30 minutes post
Blood pressure (mmHg)
Systolic	140.2 (21.0)	185.3 (25.3)	141.6 (18.2)	<0.0001 ^a,c
Diastolic	85.5 (18.4)	83.3 (17.8)	82.1 (11.9)	0.57
MAP	132.2 (21.7)	145.1 (23.0)	129.3 (16.6)	0.0002 ^a,c
Heart rate (min^−1)	74.6 (16.3)	138.7 (26.3)	77.8 (14.7)	<0.0001 ^a,c
CEC (mL^−1)	6.6 (3.8)	11.9 (7.4)	7.9 (6.6)	0.0002 ^a,c
sEsel (ng/mL)	46.9 (12.8)	53.9 (16.4)	53.4 (14.4)	<0.0001 ^a,b
vWF (IU/dL)	131.8 (23.4)	145.3 (23.3)	138.1 (27.0)	<0.0001 ^a,b,c
WBC (×10^3/µL)	6.9 (2.1)	9.2 (2.9)	7.1 (2.2)	<0.0001 ^a,c

MAP = mean arterial pressure; CEC = circulating endothelial cells; sEsel = soluble E‐selectin; vWF = von Willebrand factor.

Results expressed as mean (SD, standard deviation); P‐value refers to the results of repeated measures ANOVA. For significant differences (Tukey post hoc P<0.05): ^a pre and immediate post; ^b pre and 30 minutes post; ^c immediate post and 30 minutes post.

Figure 2 Relationship(and 95% confidence interval) between change (Δ, immediate post–pre) in endothelial markers with exercise. A: Circulating endothelial cell count (CEC) and von Willebrand factor (vWF). B: Soluble E‐selectin (sEsel) and von Willebrand factor (vWF).

Table III. Relationship between endothelial markers and exercise stress test (EST) result.

	Negative test (n = 17)	Positive test (n = 14)	P‐value
Age	55.5 (9.3)	61.9 (9.5)	0.07
Male, n (%)	14 (82)	13 (93)	0.35
BMI (kg/m^2)	27.3 (3.6)	27.2 (3.9)	0.9
Risk factors:
Previous MI	14 (82)	12 (86)	0.41
Diabetes mellitus	7 (41.2)	4 (23.6)	0.28
Creatinine (µmol/L)	84.3 (15.0)	87.3 (15.6)	0.60
EST time (minutes)	7.5 (2.8)	6.8 (2.6)	0.50
VO2 max	26.5 (10.5)	23.7 (7.7)	0.41
METS	7.6 (3.5)	7.4 (2.2)	0.82
Duke score	7.1 (3.3)	−3.7 (4.9)	<0.0001
Double‐product	26,370 (7067)	25,456 (7350)	0.73
ΔSBP (IP–pre)	45.9 (23.2)	45.2 (34.9)	0.95
Δheart rate (minute^−1)	61.5 (19.7)	67.1 (23.5)	0.50
CEC (mL^−1):
Δ (IP–pre)	5.8 (6.2)	4.7 (8.5)	0.70
Pre‐EST CEC	6.0 (3.9)	7.3 (3.7)	0.36
sEsel (ng/mL):
Δ (IP–pre)	7.9 (7.1)	6.0 (8.1)	0.50
Pre‐EST	47.8 (14.9)	45.8 (10.2)	0.67
vWF (IU/dL)
Δ (IP–pre)	15.8 (11.0)	10.5 (12.5)	0.20
Pre‐EST	129.7 (25.1)	134.4 (21.8)	0.58
WBC count (×10^3/µL):
Δ (IP–pre)	2.1 (1.4)	2.5 (1.5)	0.42
Pre‐EST	7.0 (2.3)	6.8 (1.8)	0.81

BMI = body mass index; CEC = circulating endothelial cell counts (mL⁻¹); sEsel = soluble E‐selectin (ng/dL); vWF = von Willebrand factor (IU/dL); IP = immediate post; EST = exercise stress test; WBC = white blood cell; Δ = change; SBP = systolic blood pressure; VO₂ max = maximal oxygen consumption.

Results are expressed as mean (SD, standard deviation). P‐value refers to results of unpaired t‐test.