Association between serum oxidative stress-related biomarkers and right ventricular function and their predictive value in PAH

Pulmonary arterial hypertension (PAH) is a severe heart condition, and early diagnosis is crucial for improving patient outcomes. Malondialdehyde (MDA) and superoxide dismutase (SOD) are key oxidative stress (OS) biomarkers potentially crucial to PAH development and progression. This study investigated the potential of serum MDA and SOD as early indicators for PAH detection and assessed their usefulness, along with echocardiographic right ventricular (RV) function (RVF) parameters, in evaluating PAH severity to enhance clinical diagnosis and risk assessment. A group of 73 patients diagnosed with PAH and 54 healthy individuals was recruited. Serum levels of MDA and SOD were assessed, alongside echocardiographic RVF parameters. The Wilcoxon rank-sum test was employed to assess the differences in serum MDA, SOD, and RVF. Spearman rank correlation analysis was conducted to examine the relationship between serum MDA, SOD and RVF. Furthermore, the predictive value of serum MDA and SOD for PAH was evaluated using binary logistic regression model and receiver operating characteristic curve analysis. PAH patients showed significantly elevated MDA levels, decreased SOD activity, and worsened RVF parameters, including reduced RV ejection fraction, RV fractional area change, tricuspid annular plane systolic excursion, peak systolic velocity, and enlarged right atrial, pulmonary trunk, and RV dimensions, compared to healthy group. In both the PAH and healthy groups, serum MDA was inversely related to systolic function indices (RV ejection fraction, RV fractional area change, tricuspid annular plane systolic excursion, peak systolic velocity) but directly related to structural remodeling parameters. In contrast, SOD activity was positively associated with systolic function indices and negatively with structural remodeling. The combined analysis of MDA and SOD demonstrated a sensitivity of 0.875, specificity of 0.753, and an area under the curve of 0.901. The prediction value of PAH was greatest when MDA > 5.315 nmol/ml and SOD < 50.825 ng/ml. Patients with PAH show a notable OS imbalance, with elevated MDA levels and reduced SOD activity, closely linked to RV dysfunction and structural remodeling. The elevation of MDA and the reduction of SOD in serum serve as independent risk factors for PAH, and their combined assessment offers significant predictive value for the condition. This study highlights the crucial role of OS in PAH development. A combined approach using biochemical and echocardiographic markers might improve clinical management.