The Correlation of Oxidative Stress Markers and Biochemical Cardiac Enzymes in Iraqi Patients Diagnosed with Acute Myocardial Infraction

: A myocardial infarction (MI), is the irreversible death (necrosis) of heart muscle commonly known as a heart attack. Acute myocardial infarction (AMI) occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. MI is associated with an intelligible imbalance in oxidative stress. After myocardial injury, many cardiac biomarkers become detectable in venous circulation such as cardiac enzymes. The study's main goals were to evaluate the clinical significant change in cardiac enzymes and investigate the positive and negative correlation with some serum oxidative stress markers total oxidative state (TOS), free amine and total antioxidant capacity (TAC) in patient and control groups. This study contained 120 subjects who were divided evenly into patients and control groups for the period between July and September 2022. The serum levels of oxidative stress markers were measured manually using spectrophotometer (model,


‫االساسية‬ ‫الرتبية‬ ‫كلية‬ ‫جملة‬
proteins play a crucial role in the process of muscle contraction [12].C-TnI and enzymes are crucial indicators for diagnosing and assessing the risk of individuals with symptoms indicating acute MI.The levels of troponin increase during a period of 3 to 4 hours following the onset of damage and remain elevated for a duration of 4 to 7 days for troponin I or 10 to 14 days for troponin T [4].CK-MB is an isoenzyme of the enzyme CK, which constitutes around 30% of the CK present in the myocardium.An increase of more than 5% in the overall CK activity indicates injury to the heart muscle [13].A blood level of CK-MB first occurs 4-6 hours after the onset of chest discomfort, and reaches its maximum level 10-12 hours following a myocardial infarction [14].Myocardial ischemia can also be diagnosed using lactate dehydrogenase (EC 1.1.1.27),which is present in the blood and rises 6-13 hours after an acute MI, peaks between 24-72 hours, and then returns to normal between 8-13 days [15].Another biomarker that can help in the diagnosis of acute MI is AST (EC 2.6.1.1).Blood AST levels rise 3-5 hours following an acute MI, reach a peak at 15-28 hours, and then drop back down to baseline within 5 days [16].Reactive oxygen species (ROS) are free radicals a kind of electrically charged species that have one or more unpaired electrons in their outer orbital.Any molecule containing highly reactive oxygen, for instance, has free radicals [17].Cellular function is disrupted and a number of clinical illnesses result from oxidative stress, which occurs when the equilibrium between ROS production and antioxidant defense is disturbed [18].ROS are involved in a number of human disorders, including cardiovascular disease, since they can damage or destroy cells by attacking proteins, carbohydrates, nucleic acids, and polyunsaturated fatty acids [19].
Free radicals possess the capacity to selectively attack and harm the peptide backbone as well as the amino acid side chains of proteins, leading to the creation of diverse radical protein derivatives [20].In respect of cleavage of the peptide backbone, the reaction pathway free amine and carbonyl fragments.Antioxidants, like vitamin C, are substances that safeguard cells from the harm inflicted by free radicals through accepting or donating electron (s) to remove the unpaired radical [17], [21].The study main goal where to investigate the significant positive and negative correlation of cardiac enzymes with myocardial oxidative cellular damage and antioxidant levels for early predict and treat ischemic heart attack (MI).

2-Material and methods
The research included 120 participants, 60 of whom served as healthy controls and 60 of whom were identified as having acute myocardial

3-Statistical analysis
Statistical analysis values were explained as mean ± standard deviation (SD).The comparison of was performed using Independent-Samples student's t-test where the difference is considered as highly significant when (p<0.001), significant when (p<0.05) and nonsignificant when (p>0.05).In addition, Pearson's correlation analysis is carried out to determine the relationships between all study variables.

4-Result
The obtained results showed that the mean age of MI patients and control were (55.45 ± 6.93), (53.91 ± 5.7) with a non-significant (p>0.01).Also, weight, height, and BMI mean values were non-significant (p>0.01).These non-significant obtained results for age and BMI provide a unique opportunity to conduct a comparative study accurately.The study showed that serum TOS, free amine, TnI, and VLDL significantly increase (P<0.05) in AMI patients than those of control group as shown in Table (1).;

5-Discussion
In both underdeveloped and industrialized nations, myocardial infarction ranks high among the causes of death from cardiovascular disease.AMI is the main cause of mortality as the high death rate is almost epidemic [23].Oxidative stress is a problem for the myocardium in any cardiac disease.Molecules undergo oxidative changes that quantify damage, these changes may serve as diagnostic and prognostic aids [24].When antioxidants are outnumbered by oxidants, a condition known as oxidative stress sets up and damages cardiomyocytes.However, due of early detection and treatment, mortality has decreased over the previous three decades [25].After myocardial injury many cardiac biomarker become detectable into venous circulation such as cardiac enzymes TnI, LDH, CK-MB, AST, and many other inflammatory markers.ECG changes, clinical symptoms and changes in cardiac enzymes, had used to diagnose AMI.The most extensively used approach for diagnosis is the electrocardiogram, but many times shows inclusive pattern.In such cases, serum biochemical indicators of myocardial damage become critical in confirming the diagnosis, so the use of these parameters is very important in the study [26].Therefore, there was a need to develop new parameters to increase the accuracy of the diagnostic process.
The results demonstrate a notable elevation in serum free amine levels, consistent with multiple studies that establish protein oxidation as a key marker of heightened oxidative stress in pathogenic conditions [10].This current study reveals that there is a significant positive correlation between oxidative stress markers and cardiac enzymes of cardiomyocyte.Free amine and carbonyl groups are an excellent biomarker for protein oxidation.The accumulation of oxidized protein relies on the equilibrium between prooxidant, antioxidant, and proteolytic activities [27].The study believed that oxidative modification of proteins is implicated also in myocardial infarction and another cardiovascular diseases so, free amine and carbonyl are very important markers to determine the accumulation of oxidized protein in MI patients.The total antioxidant capacity of diet associate with lower risk of heart failure.The results are close to the findings of Demirbag et al and other studies in which they have reported significant low levels of TAC in AMI patients compared to normal people [22].The TAC antioxidants protect cells from the necrosis caused by ROS due to their ability to neutralize these radicals and prevent them from causing damage through scavenging [28].
When antioxidants are present at low concentrations, oxidative stress arises, where there is an imbalance between antioxidants and oxidants [17].Finally the positive correlation between cardiac enzymes and oxidants give an influential indication for the purpose of diagnosis and treatment.

6-Conclusions
In conclusion, serum oxidants and antioxidant levels may have a good diagnostic role in MI patients, with these data indicating that the positive correlation of TOS, Free amine, TAC with cardiac enzymes may serve for the early detection of AMI and treat.

7-Acknowledgments
The authors would like to thank Mustansiriyah University (www.uomustansiriyah.edu.iq)Baghdad-Iraq for its support in the present work.
) according to patient history, symptoms, electrocardiogram (ECG), and positive cardiac troponin.The study included only men aged between 45-63 years and the healthy subjects were collected from Mustansiriyah University, as well as AMI patients were collected from Baghdad teaching hospital-medical city, Baghdad, Iraq between July and September 2022.Patients provided blood samples for the study (3-5 mL), which were collected from the brachial vein using sterile syringes and kept at room temperature for 10 minutes, then centrifuged for five minutes at a speed of 3000 rpm to separate the serum, after that the obtained serum were stored at -20ºC until the time of analysis.Patients with any associated disease were excluded.Cardiac troponin reader used for cardiac troponin I in the samples both before and after IgG depletion.The activity of AST, ALT, ALP, CK, and lipid profile was determined by using Spectrophotometric (model, Cecil, CE10N / England) commercial kit supplied from Biolabo, France.Spectrophotometric Erel method was used to determine TOS and TAC value in the samples[22].The method of Zaia et al. was used for spectrophotometric measurement of free amino groups [4].
Figuer-1: The significant correlation of TOS, CK Figure-3: The significant correlation of TnI, Free amine