title: Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy.
abstract: OBJECTIVE
  The objective of this study was to investigate functional effects of immunoadsorption (IA) in severely limited study patients with chronic nonfamilial dilated cardiomyopathy (DCM), and to analyze the prevalence of Troponin I (TNI) autoantibodies.
  
  
  BACKGROUND
  Immunoadsorption (IA) has been shown to induce early hemodynamic improvement in patients with nonfamilial DCM.
  
  
  METHODS
  We performed IA using Immunosorba columns on five consecutive days in 27 patients with chronic DCM, congestive heart failure of NYHA class >or=II, left ventricular ejection fraction below 40%, and mean time since initial diagnosis of 7.2 +/- 6.8 years.
  
  
  RESULTS
  Immediately after IA, IgG decreased by 87.7% and IgG3 by 58.5%. Median NT-pro BNP was reduced from 1740.0 ng/L at baseline to 1504.0 ng/L after 6 months (P = 0.004). Mean left ventricular ejection fraction (LVEF) was not significantly improved overall (24.1 +/- 7.8% to 25.4 +/- 10.4% after 6 months, P = 0.38), but LVEF improved >or=5% (absolute) in 9 of 27 (33%) patients. Bicycle spiroergometry showed a significant increase in exercise capacity from 73.7 +/- 29.4 Watts to 88.8 +/- 31.1 Watts (P = 0.003) after 6 months while VO2max rose from 13.7 +/- 3.8 to 14.9 +/- 3.0 mL/min kg after 6 months (P = 0.09). Subgroup analysis revealed a higher NT-pro BNP reduction in patients with shorter disease duration (P = 0.03) and without TNI autoantibodies at baseline (P = 0.05). All 9 patients with an absolute increase of LVEF of >or=5.0% were diabetic (P = 0.0001).
  
  
  CONCLUSIONS
  In this study, on severely limited heart failure patients with nonfamilial DCM, IA therapy moderately improved markers of heart failure severity in a limited subgroup of patients. This may be due to the selected study population with end-stage heart failure patients and the lower reduction of IgG3 compared to previous studies. Future blinded multicenter studies are necessary to identify those patients that benefit most.
authors: Department of Cardiology, University of Heidelberg, Heidelberg, Germany. andreas.doesch@med.uni-heidelberg.de
authors: Andreas O
authors: AO
authors: Doesch
authors: Mathias
authors: M
authors: Konstandin
authors: Sultan
authors: S
authors: Celik
authors: Arnt
authors: A
authors: Kristen
authors: Lutz
authors: L
authors: Frankenstein
authors: Stefan
authors: S
authors: Hardt
authors: Stefan
authors: S
authors: Goeser
authors: Ziya
authors: Z
authors: Kaya
authors: Hugo A
authors: HA
authors: Katus
authors: Thomas J
authors: TJ
authors: Dengler
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000276:immunology / Q000628:therapy*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D013205:Staphylococcal Protein A / Q000276:immunology*; D019210:Troponin I / Q000276:immunology; D016277:Ventricular Function, Left
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D010446:Peptide Fragments; D013205:Staphylococcal Protein A; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain