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Background 15-F2t-isoprostane (15-F2t-IsoP), a prostaglandin F2-like compound, is widely recognized as a biomarker of chronic heart failure. This study investigated the potential role and prognostic significance of plasma 15-F2t-IsoP in patients with idiopathic pulmonary arterial hypertension (IPAH). Methods Plasma 15-F2t-IsoP concentrations were determined in 80 consecutive IPAH patients at the time of their first right heart catheterization, and monitored for 30±12months. The expression of 15-F2t-IsoP protein in autopsy lung samples was determined by immunohistochemical staining. Results Plasma 15-F2t-IsoP concentrations were significantly increased in patients with IPAH compared with healthy controls (91pg/ml vs. 30pg/ml, respectively; P<0.001). Patients with baseline 15-F2t-IsoP concentrations≥97pg/ml had a significantly lower survival rate than those with lower baseline concentrations (P<0.001). During follow-up, 15-F2t-IsoP concentrations in survivors decreased, whereas concentrations in non-surviving patients increased further (P<0.05). Elevated concentrations of 15-F2t-IsoP were correlated with a severity of WHO functional class, lower 6-minute walking distance and mixed venous oxygen saturation, higher mean right atrial pressure and brain natriuretic peptide. Multivariate analysis revealed that the plasma 15-F2t-IsoP concentration was an independent factor associated with mortality. Histological studies showed that the expression of 15-F2t-IsoP was up-regulated in remodeled pulmonary vessels. Conclusions An elevated plasma 15-F2t-IsoP concentration and a further increase during follow-up may be a risk factor for higher mortality in patients with IPAH. [ABSTRACT FROM AUTHOR]