Also, we observed an interaction by unspecified catalytic and binding activity between COX and APAF-1 (apoptotic protease activating factor-1), this could an additional cause of apoptosis playing a central role in the loss of cardiomyocytes in patients with cardiomyopathy, leading to a progressive decline in left ventricular function, and CHF [59, 60]. The gene discussed is APAF1; the disease is cardiomyopathy.