Circulating endothelial cells in coronary artery disease and acute coronary syndrome

Circulating endothelial cells (CECs) have been put forward as a promising biomarker for diagnosis and prognosis of coronary artery disease and acute coronary syndromes. This review entails current insights into the physiology and pathobiology of CECs, including their relationship with circulating endothelial progenitor cells and endothelial microparticles. Additionally, we present a comprehensive overview of the diagnostic and prognostic value of CEC quantification, as well as possibilities for improvement, for example, by inclusion of CEC morphology, transcriptomics, and proteomics. The current stand of knowledge calls out for improved counting methods and consensus on a validated cell definition. Finally, our review accentuates the importance of large, well-designed, population-based prospective studies that will have to show the clinical value of CEC as a cardiovascular biomarker.