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The Role of Oxidative Products of Nitrous Oxide and The Tumor Necrosis Factor Alpha In Dilated Cardiomyopathy

1Maged Ramses Fahim, 2Sherine Maher Halim and 2Iman Kamel

1National Heart Institute Imbaba, Giza and 2Department of Clinical pathology, Elmatarya Teaching Hospital, Cairo, Egypt.

Dilated Cardiomyopathy (DCM) is a disease of the myocardium and one of the leading causes of death in patients with heart diseases. We explored the role of increased Nitric oxide and TNF-a on the pathogenesis and progression of DCM. 25 patients with DCM, and 20 apparently healthy age and sex matched controls, were studied. Patients were divided into 2 groups according to the presence or absence of pulmonary hypertension. All patients and controls were subjected to full cardiological assessment including plain chest x-ray, 12 lead ECG, and thorough 2D and Doppler echocardiography study. Laboratory investigations included measurement of plasma nitrite, nitrate and TNF-a levels. Plasma nitrite, nitrate and TNF-a concentrations were significantly elevated in DCM patients as compared to controls, and the elevation correlated with the decreasing functional status of the patients. It is concluded that plasma nitrite, nitrate, and TNF-a levels in DCM are not only linked to the severity of heart failure at presentation and during follow up, but also to the worsening of left ventricular function as evidenced by the decrease in ejection fraction and increase in end systolic and diastolic ventricular diameters during the echocardiography evaluation.