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Abstract
Cardiomyopathy are heart muscle diseases with structural and functional disorders . Progressive loss of myocytes is one of the important mechanisms in the development of heart failure.
Recently , apoptosis in myocytes has been demonstrated in human . Therefore if apoptosis is one of the mechanisms for myocytes death in DCM it is expected that factor of apoptotic signal[Fas ] will be over expressed in DCM patients.
In this work we determine the serum Fas level and evaluate correlation between sFas and clinical data . We aimed to examine the prognostic role of circulating sFas .
The circulating sFas levels in this study are increased in patients with DCM in proportion to the severity of congested heart failure and may provide prognostic information independent of left ventricular dimension.
This study included 25 patients with DCM were 10 males and 15 females their ages ranged between 6 months to 11years with mean age of 2.79 y selected from the cardiac outpatient, the Pediatric Department of Zagazig University .
Fifteen normal control were included in the study [ 9 males and 6 females ] their ages ranged from 6months to 10 years with mean age of 4.24 y.
All children were subjected to clinical evaluation ,chest x rays postero – anterior and lateral views ,electrocardiography ( ECG), Echocardiographic examination and laboratory investigations .
Circulating sFas levels in DCM were significantly higher than those in normal subjects [ 175.8 +347.76 versus 852.23 + 308.69 pg /ml, p<0.005 ] .
With respect to medical treatment [ACE inhibitors , digoxin , diuretics , β- blockers or a combination therapy] plasma sFas levels were increased in patients with dilated cardiomyopathy and the increased plasma sFas reflected the severity of associated chronic congestive heart failure . Children with DCM were stratified into 4 classes according to New York Heart Association [NYHA ]functional classification . where [4% ] was class I ; [48% ] class II ; [32 %] class III and [16% ] were class IV. The serum levels of sFas in patients with congestive heart failure [CHF] were significantly increased by increased NYHA class .
There was no significant difference between normal subjects and patient class I , but there was highly significant difference between class II ,III and control and very highly significant difference between class IV in comparison to control [ p<0.0001 ] .
Care was paid to asses the degree of impairment of the left ventricular function by determination of the left ventricular end systolic dimension [ LVESD] , ejection fraction [ EF ] ,and fraction shortening [FS] .
There was significant negative correlation between sFas levels and FS .
While there was no correlation between circulating s Fas and LVEDD , LVES D,LVPW ,Interventricular septum and EF ] .
No significant relationship between left ventricular dimensions and circulating sFas levels . Thus the activation of Fas – Fas –L system may not closely reflect the change in the left ventricular geometry in patients with dilated cardiomyopathy. CONCLUSION erum levels of sFas increase in patients with dilated cardiomyopathy and its levels increase progressively with the severity of disease so , sFas may play an important role in the pathophysilogic mechanisms of dilated cardiomyopathy in children .Circulating s Fas levels may provide a prognostic information independent of left ventricular geometry.