Ig apheresis for the treatment of severe DCM patients.
BACKGROUND
Autoantibodies against β1-adrenoreceptor (AR) are considered by many authors to be the most significant in autoimmune process during DCM. Immunoadsorption (IA) of immunoglobulins (Ig apheresis) is a logic approach to remove autoantibodies against β1-AR and other antibodies. The effect of Ig apheresis and the role of anti-β1-AR in DCM are still an issue for discussion.


METHODS
We have performed a prospective case-control study in 16 patients with DCM, NYHA Class II-IV congestive heart failure, positive and negative for anti-β1-AR.


RESULTS
We observed a clinically significant mean change of exercise tolerance compared with controls (6 MWT distance increased from 420 ± 130 m to 550 ± 150 m, p < 0.05). Systolic function improved rapidly by increase in LVEF from 28.6 ± 5.2% to 33.0 ± 10.3%, LV end-systolic and end-diastolic volumes decreased from 166 ± 58 mL to 148 ± 50 mL and from 235 ± 73 mL to 220 ± 73 mL, respectively, whereas in the control group there was no significant change in clinical variables. The improved quality of life and cardiac function in apheresis group as well as negative changes in control group didn't correlate with the presence of anti-β1-AR.


CONCLUSIONS
Ig apheresis for the treatment of DCM patients is associated with the improvement of quality of life and cardiac function regardless of the presence of anti-β1-AR. We suggest that IgG apheresis is a safe and effective method for DCM patients.
Cardiology Research Center, 15a, 3rd Cherepkovskaya Street, 121552 Moscow, Russia. Dr.Pokrovsky@mail.ru
Sergey N
SN
Pokrovsky
Marat V
MV
Ezhov
Maya S
MS
Safarova
Marina A
MA
Saidova
Viktor N
VN
Shitov
Marina I
MI
Afanasieva
Andrew I
AI
Khaustov
Irina Yu
IY
Adamova
Olga I
OI
Afanasieva
Gennady A
GA
Konovalov
D000042:Absorption; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy*; D016022:Case-Control Studies; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000276:immunology / Q000628:therapy; D006801:Humans; D007163:Immunosorbent Techniques; D007164:Immunosorbents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D018342:Receptors, Adrenergic, beta-1 / Q000276:immunology; D020127:Recovery of Function; D012426:Russia; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D001323:Autoantibodies; D015415:Biomarkers; D007164:Immunosorbents; D018342:Receptors, Adrenergic, beta-1