title: The effect of a repeated immunoadsorption in patients with dilated cardiomyopathy after recurrence of severe heart failure symptoms.
abstract: BACKGROUND
  In patients suffering from dilated cardiomyopathy (DCM), immunoadsorption with subsequent IgG substitution (IA/IgG) leads to an acute and prolonged improvement of hemodynamics and heart failure symptoms. However, some patients receiving IA/IgG experience recurrence of heart failure after an initial benefit. The aim of this study was to investigate whether a second IA/IgG treatment episode improves left ventricular systolic function and further mitigates heart failure symptoms in these patients.
  
  
  METHODS
  We retrospectively analyzed 15 DCM patients who experienced a significant improvement of LVEF (≥ 5% absolute or ≥ 20% relative) and heart failure symptoms (≥ 1 NYHA functional class) but a subsequent deterioration (decline in LVEF ≥ 5% absolute or ≥ 20% relative and NYHA worsening ≥1 class) after the first IA/IgG. These patients underwent a second IA/IgG treatment 41.7 ± 27.4 months after the first cycle. Follow up data were acquired 3-6 months after both IA/IgG treatments.
  
  
  RESULTS
  The first IA/IgG induced an improvement of LVEF from 33 ± 6.4% to 43.2 ± 7.9% (P < 0.001) and of mean NYHA functional class from 2.9 ± 0.26 to 1.8 ± 0.56 (P < 0.001). The second treatment was associated with a significant improvement in LVEF (from 29.7 ± 4.6% to 34.9 ± 8.3%, P = 0.013) and NYHA functional class (2.87 ± 0.64 to 2.33 ± 0.72; P = 0.02). This improvement was less pronounced compared to the first treatment with respect to both, LVEF (P = 0.09) and NYHA improvement (P = 0.04).
  
  
  CONCLUSIONS
  In DCM patients, who experience a significant improvement of LVEF and heart failure symptoms after IA/IgG but a subsequent relapse during follow up, repeated IA/IgG may be considered.
authors.affiliation: Department of Cardiology, Medical University of Greifswald, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Reinthaler
authors.affiliation: Department of Cardiology, Medical University of Greifswald, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Empen
authors.affiliation: Department of Cardiology, Medical University of Greifswald, Germany.
authors.forename: Lars R
authors.initials: LR
authors.lastname: Herda
authors.affiliation: Department of Cardiology, Medical University of Greifswald, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Schwabe
authors.affiliation: Department of Cardiology, Medical University of Greifswald, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rühl
authors.affiliation: Department of Cardiology, Medical University of Greifswald, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.affiliation: Department of Cardiology, Medical University of Greifswald, Germany.
authors.forename: Stefan B
authors.initials: SB
authors.lastname: Felix
mesh_terms: D000368:Aged; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000276:immunology / Q000628:therapy*; D004452:Echocardiography; D016552:Ergometry; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000276:immunology / Q000628:therapy*; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D007074:Immunoglobulin G / Q000737:chemistry* / Q000276:immunology; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013147:Spirometry; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D007074:Immunoglobulin G
keywords: dilated cardiomyopathy; heart failure; repeated immunoadsorption