Vol 31, No 2 (2024)
Original Article
Published online: 2023-09-12

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Application of homocysteine as a non-invasive and effort-free measurements for risk assessment of patients with pulmonary hypertension

Mei-Tzu Wang123, Pei-Ling Chi4, Chin-Chang Cheng25, Wei-Chun Huang235, Lee-Wei Chen617
Pubmed: 37772357
Cardiol J 2024;31(2):285-299.

Abstract

Background: Current guideline-recommended multiparameters used to assess the risk levels of
pulmonary arterial hypertension (PAH) are invasive hemodynamic measurements or effort-dependent
exercise tests. Serum natriuretic peptide is only one kind of effort-free biomarker that has been adopted
for risk assessment. This study aimed to investigate the application of homocysteine as a non-invasive
and effort-free measurement for the risk assessment of patients with PAH.
Methods: Samples of 50 patients diagnosed with PAH via right heart catheterization were obtained,
and the patients were divided into low-, intermediate- and high-risk groups for further analysis. Additionally,
serum N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) and homocysteine
levels of monocrotaline (MCT)-induced PAH rats were analyzed at each week with progressed severity
of PAH, and they were sacrificed on day 28 with pathology being assessed.
Results: Hyperhomocysteinemia was an independent predictor (odds ratio [OR]: 1.256; 95% confidence
interval [CI]: 1.002–1.574) and showed a linear correlation with NT-proBNP. Hyperhomocysteinemia
could discriminate between low/intermediate and high-risk levels in PAH with a cut-off value
in 12 μmol/L. Moreover, the elevated homocysteine levels by weeks in MCT rats also demonstrated the
association between homocysteine and the severity of PAH.
Conclusions: Homocysteine can be a non-invasive and effort-free risk assessment for patients with
pulmonary hypertension. Homocysteine level had a linear correlation with NT-proBNP level, and patients
with hyperhomocysteinemia had a higher risk level, higher NT-proBNP level, and decreased lower
diffusing capacity for carbon monoxide. The correlation between homocysteine level and PAH severity
was also demonstrated in MCT rats.

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