Serum homocysteine, asymmetrical dimethylarginine and nitric oxide levels in children with pulmonary arterial hypertension

In this study it is aimed to investigate the reproducubility of Homocysteine, ADMA and NO levels as biomarkers and the correlation of echocardiographic and catheter angiographic findings in patients with PAH.A total of 70 individuals composed of 30 patients with PAH, 20 patients having left to right shunt without PAH and 20 healhty controls have been included in the study. Detailed history, physical examination findings, anthropometric values, telecardiography, ECG, ECHO, catheter angiography and CBC values were recorded on previously designed patient forms. Homocysteine, ADMA and NO levels in blood samples were measured by ELISA method.Fifteen patients (50%) with PAH were female and 15 (50%) were male with an age range of 12 months to 26 years whereas 12 (60%) of the patients having congenital heart diseases (CHD) were female and the rest 8 patients (40%) were male and their ages ranged between 2 months to 16 years. Both Homocysteine and ADMA levels of PAH patients were found to be higher than CHD patients and healthy controls (p<0,05, Table 16) however this difference was not significant for the latter parameter in between the PAH patients and CHD patient group. No statistically significant difference was detected in any of the groups regarding NO levels. Comparison of the cyanotic and acyanotic patients in PAH group revealed significantly higher Homocysteine levels in the cyanotic subgroup. The SPAB, DPAB, OPAB, Rp and Rp/Rs values of PAH patients were found to be higher than the CHD group (p<0,05). It was shown that there were no correlation in between the ECHO and hemodynamic parameters and measured Homocysteine, ADMA and NO levels in patients with PAH.It is concluded that elevated Homocysteine and ADMA levels in patients with PAH contributes to development of PAH together with other predisposing factors and therefore these biological markers could add some more data in diagnosing and monitoring of the treatment in PAH patients together with other routine tests. However, we think that reproducibility of these parameters are needed to be evaluated by means of large, multicentric and prospective studies.Key words : Pulmonary arterial hypertension, homocysteine, ADMA, NO.