Reduction of morbidity by immunoadsorption therapy in patients with dilated cardiomyopathy.
BACKGROUND
In patients with dilated cardiomyopathy (DCM) and severe congestive heart failure, immunoadsorption (IA) and subsequent IgG substitution leads to an acute and prolonged hemodynamic improvement. Goal of this study was to investigate the long-term effect of immunoadsorption on morbidity.


METHODS
In a retrospective analysis of 34 patients (17 patients who have received immunoadsorption therapy and 17 control patients) were included. Inclusion criteria were DCM, left ventricular ejection fraction less than 35%, NYHA classes II-III. The average time after immunoadsorption was 3.0 years (median 2.3 years). Both groups did not differ concerning sex, age, duration of disease, medication, baseline ejection fraction and NYHA class.


RESULTS
In patients who have received immunoadsorption (IA) the days of hospitalisation for congestive heart failure per year could be significantly reduced in contrast to the control patients (17.2 days prior to IA, 4.3 days after IA). Even if the procedural days for immunoadsorption were included there was still a significant reduction of hospitalisation if IA therapy was longer than 2.5 years ago. The days of hospitalisation increased gradually with time during the follow up period. IA induced an acute increase in EF (19.8-25.7%, p<0.01 vs. baseline).


CONCLUSIONS
IA not only leads to an acute hemodynamic improvement in patients with DCM but may also reduce morbidity in these patients during the next 3 years.
Knebel
Fabian
F
Medizinische Klinik der Charité, Humboldt-Universität zu Berlin, Schumannstr. 20/21, 10117 Berlin, Germany. fabian.knebel@charite.de
Böhm
Marco
M
Staudt
Alexander
A
Borges
Adrian C
AC
Tepper
Mirko
M
Jochmann
Nicoline
N
Wernicke
Klaus D
KD
Felix
Stephan
S
Baumann
Gert
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000453:epidemiology* / Q000628:therapy*; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007163:Immunosorbent Techniques; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D013995:Time
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D004077:Digoxin