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Acute myocardial infarction (AMI) is a myocardial necrosis occurring due to persistent coronary ischemia, in which inflammation plays an important role and heart failure is a common complication. The present work was undertaken to clarify the role of Tumor Necrosis Factor Alpha (TNF-alpha) in acute myocardial infarction (AMI). The study was conducted on 20 newly diagnosed AMI patients and 10 healthy age and sex matched controls. Sequential estimation of plasma TNF alpha level was carried out at admission, 24 and 48 hours post admission using ELISA. AMI patients showed a significant increase of plasma TNF-alpha level on admission, and 24 hours post admission but not after 48 hours. However, a significant increase was still seen at 48 hours post admission in patients with signs of heart failure but not in those without signs of heart failure. A significant positive correlation was found between plasma TNF-alpha level and CPK level at admission. On the other hand a significant negative correlation was found between these 2 parameters at 24 and 48 hours post admission. It is concluded that TNF-alpha may be an early marker of myocardial damage because of the early increase of its level after ischemic injury instead of being late consequence of extensive tissue necrosis. TNF-alpha level may be an important indicator of the severity of AMI and the occurrence of heart failure.

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-alpha 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-alpha levels. Plasma nitrite, nitrate and TNF-alpha 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-alpha 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.