title: Short-term hemodynamic effects of immunoadsorption in dilated cardiomyopathy.
abstract: BACKGROUND
  Previous studies have shown that the sera of many patients with dilated cardiomyopathy (DCM) are positive for several antibodies directed against cardiac antigens. Anti-beta1-adrenergic receptor antibodies occur in 70% to 90% of DCM patients. These antibodies are extractable by immunoadsorption (IA). In an investigation of the functional significance of antibodies for hemodynamics, IA was performed throughout 5 consecutive days on nine patients with severe DCM who were on stable drug therapy.
  
  
  RESULTS
  Immunoglobulins were eliminated in nine patients with severe DCM (mean age, 43.5 years; range, 25 to 58 years; left ventricular ejection fraction, <25%). IA was performed over 5 consecutive days with an immunoadsorber for immunoglobulin. All patients were on stable medication, including ACE inhibitors, digitalis, and diuretics. All patients received beta-blockers. During therapy, hemodynamic parameters (mean+/-SD) were monitored with a Swan-Ganz thermodilution catheter. IA elicited a decrease of anti-beta1-adrenergic receptor antibodies from 6.4+/-1.3 to 1.0+/-0.5 relative units. During IA, cardiac output increased from 3.7+/-0.8 to 5.5+/-1.8 L/min, P<.01. Mean arterial pressure decreased from 76.0+/-9.9 to 65.0+/-11.2 mm Hg, P<.05; mean pulmonary arterial pressure, from 27.6+/-7.7 to 22.0+/-6.5 mm Hg, P<.05; left ventricular filling pressure, from 16.8+/-7.4 to 12.8+/-4.7 mm Hg, P<.05; and systemic vascular resistance, from 1465+/-332 to 949+/-351 dyne x s x cm(-5), P<.01.
  
  
  CONCLUSIONS
  In addition to conventional medical treatment, IA may be an additional therapeutic possibility for acute hemodynamic stabilization of patients with severe DCM.
authors.affiliation: Department of Internal Medicine I, Humboldt University, Berlin, Germany.
authors.forename: W V
authors.initials: WV
authors.lastname: Dörffel
authors.forename: S B
authors.initials: SB
authors.lastname: Felix
authors.forename: G
authors.initials: G
authors.lastname: Wallukat
authors.forename: S
authors.initials: S
authors.lastname: Brehme
authors.forename: K
authors.initials: K
authors.lastname: Bestvater
authors.forename: T
authors.initials: T
authors.lastname: Hofmann
authors.forename: F X
authors.initials: FX
authors.lastname: Kleber
authors.forename: G
authors.initials: G
authors.lastname: Baumann
authors.forename: P
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood* / Q000276:immunology; D001327:Autoimmune Diseases / Q000276:immunology / Q000503:physiopathology*; D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D005112:Extracorporeal Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood* / Q000276:immunology; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D018342:Receptors, Adrenergic, beta-1 / Q000276:immunology*; D013318:Stroke Volume
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D018342:Receptors, Adrenergic, beta-1