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Coronary sinus oxidative stress markers allow for accurate assessment of the prognosis in patients with advanced heart failure awaiting transplantation


 
 
 Oxidative stress is a cause of cardiac diseases and contribute to apoptosis, cardiac remodeling, cardiac growth and repair. The end-stage heart failure (HF) is associated with ischemia-reperfusion, increased neurohumoral activity, cytokine stimulation and presence of inflammatory cells. Above factors are stimuli which generate free radicals and can induce oxidative stress in the heart and cause damage to essential myocardial structures and function. However, the role of oxidative stress in end-stage HF has not been fully understood.
 
 
 
 This study aimed to evaluate the prognostic value of the oxidative stress markers in ambulatory patients with end-stage HF awaiting heart transplantation (HT) during a 1.5 year follow-up period.
 
 
 
 The study was a prospective analysis of 85 optimally treated adult patients with end-stage HF, who were added to the HT waiting list at the Cardiology Department between 2015 and 2016. At the time of enrollment to the study routine laboratory tests, cardiopulmonary exercise test, echocardiography, spirometry and right heart catheterization were performed in all patients. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine total oxidant status (TOS) and total antioxidant capacity (TAC) levels. TOS and TAC were measured by Erel's method. The endpoint was all-cause mortality during a 1.5 years follow-up. The Medical University of Silesia's local Institutional Review Board approved the study protocol, and all patients provided informed consent.
 
 
 
 Median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. During the observation period, the mortality rate was 40%. The area under the receiver operating characteristics (ROC) curves indicated an acceptable discriminatory power of TAC (AUC: 0.780 [CI: 0.677–0.883]; sensitivity 56%, and specificity 90%); and excellent power of TOS (AUC: 0.9530 [CI: 0.9279–0.9781]; sensitivity 88%, and specificity 94%) for 1.5 years mortality. Patients with a low TAC level (≤1.10) had a significantly worse 1.5-year survival compared to the group with a high TAC level (>1.10) (1.5 year survival: 20.8% versus 75.4%; (long rank p<0.001). Similarly, patients with a high TOS level (≥3.11) had a significantly worse survival compared to the group with a low TOS level (<3.11) (1.5- year survival: 9.1% versus 92.3%; p<0.001).
 
 
 
 TAC with acceptable prognostic power and TOS with excellent prognostic power allows assessment of the prognosis in end-stage HF during a 1.5 year follow-up period.
 
 
 
 Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia, Katowice, Poland
