الفهرس 
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Abstract
<Plasma levels of ET1 and ANP were significantly elevated in all studied groups than in control group even in mild cases. Also they were significantly higher in severe cases than moderate and in moderate than mild cases Plasma ET1 and ANP have a significant correlation with the prognosis. The patients with higher plasma ET1 and ANP levels showed poor response to medical treatment and poor prognosis than those with lower levels. There is significant reduction in ET1 and ANP plasma levels after medical treatment but their levels remain higher in severe cases than in moderate and in moderate than mild cases also, their levels were still higher in mild cases than control group i.e. the reduction with treatment did not reach the normal level. In patients with heart failure due to left to right shunt, we found that plasma ET1 and ANP have significant positive correlation with Qp:Qs as an indicator of excess pulmonary blood flow and severity. They also positively correlated with LVDD, LVSD, LAD (LV end diastolic diameter, LV end systolic diameter, left atrial diameter respectively) as indicators of volume overload to which the heart was exposed. In patients with dilated cardiomyopathy, ET1 and ANP were significantly negatively correlated to fractional shortening %, also, they positively correlated with LVDD. In patients with diastolic heart failure due to restrictive cardiomyopathy, we found that plasma ET1and ANP levels are correlated with E/A ratio of the left ventricular inflow , deceleration time and isovolumetric relaxation time as parameters of severity of the disease. In patients with pressure overload as a cause of left ventricular failure, the study revealed that plasma ET1 and ANP were elevated in these cases with increasing levels in parallelism to the clinical scoring and also significantly correlated with the pressure gradient to which the left ventricle is exposed as well as the ratio between the left ventricular mass to the left ventricular end diastolic volume as a marker to the degree of LV hypertrophy. <U+2022> In patients with rightsided heart failure due to pulmonary hypertension, we demonstrated that plasma ET1 and ANP levels are significantly elevated in this group and increase more with the increase in severity. Plasma ET1 significantly correlated with right ventricular function echocardiographic parameters in the form of dp/dtmax (the mean rate of rise in right ventricular pressure), dp/dt/PGmax (PGmax: maximum pressure gradient of tricuspid regurge) and mean pulmonary artery pressure (MPAP) as an indicator of the degree of pulmonary hypertension. Comparing the results between the different five etiologic groups regarding their ET1 and ANP plasma levels before and after treatment, we found that there is no significant difference in the studied neurohumoral profile between the studied groups according to the etiology.