Effect of enalapril on left ventricular remodeling and plasma level of tumor necrosis factor-alpha in children with dilated cardiomyopathy

Abstract EN

-Background : cardiomyopathy represents a group of diseases of the heart which involves the heart muscle itself.

"Remodeling" is a variety of alterations in left ventricular (LV) morphology and volume, with a significant reduction in LV systolic and diastolic performance. Aims : the aim of this intervention study was to assess the left ventricular remodeling and the plasma level of TNF-a in children with dilated cardiomyopathy and the effect of Enalapril therapy on them.

Methods : the study comprised 40 children of age ranged (2-5 years) who were previously diagnosed as having dilated cardiomyopathy with a left ventricular ejection fraction (EF) measurements at least <35% within the preceding 3 months prior to study.

Group I (Enalapril-treated): included 20 patients who were assigned to be treated with Enalapril as an ACE inhibitor plus digoxin, furosemide, and L-carnation.

Group II: included 20 patients who were under the ordinary line of management of DCM (digoxin, furosemide, captopril, and L-carnation).

Results: Results of this study revealed that (pre intervention) all echocardiography findings and plasma TNF-a values among patients in group I were insignificantly different than those in group II (P>0.05 respectively).

Using Enalapril in a dose of (0.1-0.3 mg/kg/day) twice daily among patients in group I leads to a significant increase in E/A ratio, EF%, FS% from 1.18±0.75, 33.4 + 1.2,17 ± 0.94 pre intervention to 1.38 ± 0.76, 54.2 + 5.1, 28 ± 3.1 three months post intervention respectively and up to 1.86 + 0.42, 62.6 + 4.9, 36.8 + 2.8 six months post-intervention respectively, while the mean levels of LVESV, sphericity index, LV mass, LV systolic wall stress and TNF-a plasma level had been significantly decreased from 68.1 + 19.6 ml, 0.83 ± 0.18, 148.6 ± 43.8gm, 248.9 + 38.2 dyne / cm2, 6.12±0.94 ng / ml pre intervention respectively to 45.6 ± 14.1 ml, 0.65 ± 0.22, 110.7±16.1 gm, 204.5 ± 29.7 dyne / cm2, 5.6 ± 0.7 ng / ml three months post intervention respectively and up to 34.8 ± 8.2 ml, 0.56±0.19, 111.4 ± 50.1 gm,185.5±29.1 dyne / cm2, 5.36 ± 0.7 ng / ml six months post-intervention (P < 0.001 respectively). Conclusion : the use of Enalapril therapy was associated with improvement of both systolic and diastolic LV functions, regression of LV remodeling, and decreased plasma level of TNF-a.