ABSTRACT
Apoptosis plays a pivotal role in the progression of the pathogenesis of several cardiovascular diseases including heart failure. The aim of this study was to measure serum levels of soluble apoptosis mediators; Fas [sFas] and Fas ligand [sFasL] in children with congestive heart failure [CHF] of different etiologies, and their relation to each other and to the severity of heart failure in these patients. Sixty patients [29 males and 31 females, age; 6.73 +/- 3.18 years] complaining from congestive head failure [NYHA class III/IV] selected from the pediatric department in Al-Minya [university Hospital, from the period of February 2004 to July 2005. The patients were divided into 3 groups according to the etiology of heart failure. Group 1, caused by congenital heart disease [CHD] in 18 cases, group 2 caused by rheumatic valvular head disease [RHD] in 29 cases, and group 3, caused by dilated cardiomyopathy [DCM], in 13 cases. Twenty healthy children, matched for age and gender, were used as controls. Serum levels of soluble Fas [sFas] and Fas-ligand in patients and controls were determined by Enzyme-Linked lmmuno-Sorbent Assay. The results showed that the serum levels of sFas and sFasL were significantly higher in patients with CHF compared to controls [p: 0.001 and p: 0.04, respectively]. Patients with CHF due to CHD had significantly higher levels of sFas and sFasL compared to controls [p: 0.001 and p: 0.002 respectively]. Also, patients with CHF due to RHD had significantly higher levels of sFas and FasL compared to controls [p: 0.001 and p; 0.04 respectively]. Similarly, patients with DCM had significantly higher levels of sFas and FasL compared to control group [p: 0.001 and p: 0.005 respectively]. Serum FasL correlated positively to sFas [r: 0.32, p: 0.049], and heart rate [r: 0.30, p: 0.044], and correlated negatively to ejection fraction [r: -0.46, p: 0.03], but had no significant correlation with ESR, or CRP. Serum levels of sFas and sFasL are increased in children with CHF of different etiologies suggesting a potential role of Fas and FasL in this setting. Levels of sFasL are increased in proportion to the severity of heart failure and may provide a useful marker for evaluating the severity and prognosis of heart failure