Soluble Fas as an apoptotic marker in myocardial infarction, the outcome and its relation to high risk clinical features

الملخص EN

Apoptosis contributes to myocardiocyte loss in cardiac disease and may be a major determinant for the development of early symptomatic heart failure (HF).

This study was designed to detect the impact of apoptosis on prognosis and clinical outcome in patients with myocardial infarction (MI) and its relation to the other risk factors for coronary artery disease.

Forty patients (twenty two males, eighteen females) with mean age 53.88±1.39 years diagnosed as MI on the basis of electrocardiographic and enzymatic changes in addition to the clinical symptoms and signs.

Twenty-two were smokers.

Fifteen healthy volunteers were chosen as a control group.

Patients, group was classified according to: A) infarct size (extensive Ml 62.5%, localized MI 37.5%).

B) Presence or absence of heart failure (MI with HF 67.5%, MI without HF 32.5%).

C) Presence or absence of diabetes mellitus (DM) (MI with DM 47.5%, MI without DM 52.5%).

D) Presence or absence of hypertension (HTN) (MI with HTN 47.-5%, MI without HTN 52.5%).

For every participant, history and clinical examination paying special attention to vital signs and cardiopulmonary examination, as well as resting electrocardiogram (ECG) looking for the changes of MI were done.

In addition, the following laboratory investigations: serum sugar, total cholesterol, triglycerides, soluble Apo-l/Fas, homocysteine and nitric oxide (NO) concentrations in serum were assessed.

The serum levels of soluble Fas, homocysteine and nitric oxide (NO), were significantly higher in MI patients than in the controls (P<0.001).

As regard serum levels of soluble Fas in patients with MI, there were significantly higher values in patients with extensive lesions and in those associated with HF in comparison to patients with localized lesions and patients not associated with HF (P<0.001) Serum leveLof homocysteine was significantly higher in normotensive patients with MI and in non-diabetic patients with MI when compared with MI patients associated with hypertension or diabetes mellitus (P<0.05, <0.001 respectively).

Serum level of NO was significantly higher in normotensive patients with MI than in hypertensive patients with MI (P<0.001), it was also significantly higher in patients with localized MI than in patients with extensive MI (P<0.001) and in patients with compensated heart than in patients with symptomatic HF (P<0.001).

We concluded that soluble Fas as a marker of myocardial apoptosis is strongly associated with and may be a major determinant of unfavorable early symptomatic post-infarction HF and is related to the size of MI.

Homocysteine acts as independent risk factor for atherosclerotic cardiovascular events and the decreased level of NO is associated with increased risk for development of atherosclerosis, HTN and symptomatic left ventricular dysfunction (LV.dysfunction).