Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy.
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.
Doesch
Andreas O
AO
Department of Cardiology, University of Heidelberg, Heidelberg, Germany. andreas.doesch@med.uni-heidelberg.de
Konstandin
Mathias
M
Celik
Sultan
S
Kristen
Arnt
A
Frankenstein
Lutz
L
Hardt
Stefan
S
Goeser
Stefan
S
Kaya
Ziya
Z
Katus
Hugo A
HA
Dengler
Thomas J
TJ
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
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