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

ABSTRACT

In myocardial infarction [MI], activation of soluble fas which is a widely expressed cell surface receptor can induce apoptosis in cardiac myocytes. Apoptosis contributes to myocardiocyte loss in cardiac disease and may be a major determinant for the development of early symptomatic heart failure [HF] but the precise role of apoptosis in the development of cardiac dysfunction need to be established. To detect the impact of apoptosis on prognosis and clinical outcome in patients with myocardial infarction and its relation to the other risk factors for coronary artery disease. Forty patients [22males, 18 females] with mean age 53.88"1.39 years diagnosed as MI on the bases of electrocardiographic and enzymatic changes in addition to the clinical symptoms and signs.Twenty two out of them were smoker. Fifteen healthy volunteers, age and sex matched with the patients as control group has been enrolled in this study. Patient group were classified according to A- Infarct size [extensive MI 62.5%, localized MT 37.5%]. B- Presence or absence of heart failure [Ml with HF 67.5%, MI without HF 32.5%]. C- Presence or absence of DM [Ml with DM 47.5%, MI without DM 52.5%]. D- Presence or absence of hypertension [Ml with hypertension 47.5%, Ml without hypertension 52.5%]. For every participant, history and clinical examination paying especial attention to vital signs and cardiopulmonary examination, resting electrocardiogram [ECG] looking for the changes of MI and the following laboratory investigation blood sugar, total choleserol, triglycerides, nitric oxide [NO], Apo-l/fas, and homocysteine concentrations in serum were measured. The serum levels of fas, nitric oxide [NO] and homocysteine are significantly higher in the 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 lesion and in those associated with HF when compared to patients with localized lesion and patients not associated with HF respectively [p<0.001]. Serum level of NO was significantly higher in normotensive patients with MI than in hypertensive patients with MI [p<0.001]. Also the serum level of NO was significantly higher in patients with extensive MI than in patients with localizes MI [p<0.001] and significantly higher in patients with compensated heart than in patients with symptomatic HF [p<0.001]. Serum level of homocysteine is significantly higher in normotensive patients with MI and in non diabetic patients with MI when compared to MI patients associated with hypertension or diabetes mellitus [p<0.05, <0.001 respectively]