Evaluation of oxidative status in pulmonary arterial hypertension

Aim: Pulmonary arterial hypertension (PAH) is a disease with high mortality and morbidity rates. Therefore, early diagnosis and treatment of the disease are extremely important. Pulmonary hypertension (PH) is a progressive disease that leads to an increase in pulmonary vascular resistance and right ventricular failure. The role of oxidative stress, inflammation and vascular dysfunction in the pathogenesis of PH is increasingly recognized. In this study, we aimed to investigate the relationship between ischaemia-modified albumin (IMA), paraoxonase 1 (PON 1) and arylesterase (ARES) levels, which have been shown to vary with oxidative stress, and other laboratory parameters in patients who underwent right heart catheterisation with suspicion of PH and were diagnosed with PAH and healthy subjects. Materials and Methods: Between March 2023 and December 2023, 46 patients who underwent right heart catheterisation (RHC) with suspicion of PH in the Cardiology Clinic of Süleyman Demirel University Faculty of Medicine between March 2023 and December 2023 and who were diagnosed with PAH as a result of RHC and 38 healthy patients were included in the study. Serum IMA, PON 1 and ARES levels and other laboratory parameters were compared between patients with PAH and healthy subjects. Results: ARES was 542.88 (474.54-722.25) U/L in the PAH group while 706.80 (612.69-767.51) U/L in the healthy group (p:0.001), PON 1 was 308.56 (229.93-369.71) U/L in the PAH group while 372.35 (332.94-436.06) U/L in the healthy group (p: 0.002), IMA was 66.78 (59.28-80.84) g/L in the patient group while 61.92 (57.32-67.67) g/L in the healthy group (p: 0.037) and the difference was statistically significant. A negative correlation was found between mean pulmonary artery pressure (PAP) and ARES, PON 1, Lymphocyte, Basophil, Mean erythrocyte hemoglobin, Mean erythrocyte hemoglobin concentration, Chlorine, Albumin and Iron. A positive correlation was found between mean PAB and IMA, B-type natriuretic peptide (BNP), Neutrophil/Lymphocyte raito, Red blood cell, Red cell distribution width, D-dimer, Sensitive C-reactive protein (CRP), Urea, Uric acid, Direct bilirubin, Alkaline phosphotase (ALP), Serum iron binding capacity and Pulmonary artery wedge pressure. In order to evaluate the power of the variables in predicting PAB, single regression was performed for the variables with significant difference between the groups. In the single regression analysis, ARES (b: 1.006, 95% CI: 1.002-1.010, p: 0.001), PON 1 (b: 1.008, 95% CI: 1.003-1.013, p: 0.002), IMA (b: 0. 93, 95% CI: 0.87-0.98, p: 0.007), Sensitive CRP (b: 0.93, 95% CI: 0.87-1.01), p: 0.101), Urea (b: 0.94, 95% CI: 0.91-0.98, p: 0.01), Uric acid (b: 0. 58, 95% CI: 0.42-0.81, p: 0.01), Gamma-glutamyl transferase (b: 0.96, 95% CI: 0.93-0.99, p: 0.016), ALP (b: 0.97, 95% CI: 0.95-0.99, p: 0. 006), direct bilirubin (b: 0.00002, 95% CI: 0.00001-0.002), albumin (b: 3.9, 95% CI: 1.13-13.51), BNP (b: 0.96, 95% CI: 0.94-0.98, p:<0.001) were detected. Conclusion: In our study, serum IMA levels were found to be statistically significantly higher in PAH patients compared with healthy subjects, ARES and PON 1 levels were found to be statistically significantly lower in PAH patients compared with healthy subjects. Considering that oxidative stress and inflammation play an important role in the pathogenesis of PH, the evaluation of IMA, PON 1 and ARES levels together is important for a better understanding of the disease and the development of possible new treatment strategies. Oxidative stress markers such as PON 1 and IMA, cardiac overload indicators such as BNP and inflammatory markers such as uric acid, bilirubin and sensitive CRP provide valuable information in the diagnosis and management of PH. Evaluation of these markers in combination may be useful in the early diagnosis and follow-up of PH.