title: [Immunomodulating treatment in advanced heart failure--effect of intravenous immunoglobulin].
abstract: BACKGROUND
  Congestive heart failure is characterised by enhanced immune activation. Immune-mediated mechanisms may play a pathogenic role, hence the growing interest in therapeutic regimens that could modulate the immune response in heart failure.
  
  
  METHODS
  In the present report we discuss the pathogenic role of immunological and inflammatory mediators in the pathophysiology of heart failure and discuss different treatment modalities with focus on our recent study with intravenous immunoglobulin. In that study 40 patients with symptomatic chronic heart failure and left ventricular ejection fraction (LVEF) < 40% were randomised in a double-blind fashion to receive therapy with immunoglobulin or placebo for a total period of 26 weeks.
  
  
  RESULTS
  We found that intravenous immunoglobulin, but not placebo, shifted the cytokine balance in an anti-inflammatory direction, and that such a shift was associated with improvement in LVEF by 5 EF units. Functional capacity and haemodynamic variables also improved.
  
  
  CONCLUSIONS
  Our study supports the hypothesis that immunological variables might be of significant importance in the pathogenesis of heart failure and it suggests a potential for immunomodulating therapy in addition to optimal conventional cardiovascular treatment regimens in such patients. These issues are further discussed in the present article.
authors.affiliation: Nukleaermedisinsk seksjon Klinisk kjemisk avdeling Rikshospitalet 0027 Oslo. lagulles@online.no
authors.forename: L
authors.initials: L
authors.lastname: Gullestad
authors.forename: H
authors.initials: H
authors.lastname: Aass
authors.forename: A K
authors.initials: AK
authors.lastname: Andreassen
authors.forename: H
authors.initials: H
authors.lastname: Ihlen
authors.forename: S
authors.initials: S
authors.lastname: Simonsen
authors.forename: J
authors.initials: J
authors.lastname: Kjekshus
authors.forename: L
authors.initials: L
authors.lastname: Wikeby
authors.forename: S
authors.initials: S
authors.lastname: Nitter-Hauge
authors.forename: J G
authors.initials: JG
authors.lastname: Fjeld
authors.forename: E
authors.initials: E
authors.lastname: Lien
authors.forename: T
authors.initials: T
authors.lastname: Ueland
authors.forename: S S
authors.initials: SS
authors.lastname: Frøland
authors.forename: P
authors.initials: P
authors.lastname: Aukrust
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D016207:Cytokines / Q000097:blood / Q000276:immunology; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left / Q000276:immunology / Q000502:physiology
chemical_list: D000276:Adjuvants, Immunologic; D016207:Cytokines; D016756:Immunoglobulins, Intravenous