NEUROHORMONAL ACTIVATION, OXYGEN FREE RADICALS AND APOPTOSIS IN THE MECHANISM OF CONGESTIVE HEART FAILURE

Abstract

Introduction: A Characteristic feature of heart failure is the deterioration ofleft ventricular function. A role of immune disturbance has been proposed in CHF, one of them is the cytokines specially TNFa.. Moreover the syndrome of heart fuilure may result from progressive loss of cardiac cells due to apoptosis. Apoptosis can be triggered by haemodynamic and neurohormonal factors or increased oxidative stress within the failing heart. Patients & Methods: This study was conducted on 51 patients in CHF and 10 healthy control subjects. The patients were classified into 3 groups according to New Yorlc Heart association, 6 were in functional class II, 12 in class Ill and 33 in class IV. Patients were subjected to history taking and full clinical examination, chest X-ray echocardiologic studies and blood analysis ofTNFa, angiotensin lland plasma renin activity, sFas and Nitric oxide. Results: There was a significant increase in the TNFa concentrations on comparing group I,lland mto group IV. TNFu was positively correlated with the sFas r=0.38 at a p value =0.003 and was positively correlated with plasma renin activity r=0.337 at a p value =0.01 and with ANG llr=0.385 at a p value =0.002. The hormone renin was increased significantly in all the studied groups compared to the control. There was also a significant increase in the plasma Angiotensin II levels on comparing groups I,lland Ill with the control group. Angiotensin II was positively correlated with the sFas r=0.385 at a p value =0.02. sFas levels varied significantly from those of normal control subjects (group IV) in all the groups ofthe study (group l,Il and ill. Conclusion From this worlc we can conclude that the immune system is activated in the congestive heart failure The Renin ANG system plays a role in the pathogenesis a..,d progression of congestive heart failure. Nitric oxide was significantly increased in all patients.