Immunoadsorption can improve cardiac function in transplant candidates with non-ischemic dilated cardiomyopathy associated with diabetes mellitus.
BACKGROUND
Diabetes mellitus (DM) is a risk factor for death from heart failure (HF) in patients with dilated cardiomyopathy (DCM) but DM patients are less eligible for heart transplantation (HTx) and DM is a risk factor for death also after HTx. New therapies are therefore necessary to improve survival of diabetic DCM patients. Immunoadsorption (IA) can improve heart function in DCM but its usefulness for therapy of DM-associated DCM is unknown. We assessed this aspect.


METHODS
Cardiac function and HTx-free survival were evaluated in diabetic HTx-candidates with DCM who underwent IA (Globaffin(®), a broadband-immunoadsorber containing synthetic peptide-GAM(®)) in 6/2003-6/2012 (follow-up 1-10 yrs). Non-diabetic HTx-candidates with DCM who received IA in the same time-period served as controls. Before and after IA patients were tested for serum β1-autoantibodies (β1-AABs).


RESULTS
We evaluated 31 patients with and 31 without DM. Before IA there were no differences between the 2 groups in LV size, LVEF and β1-AAB levels. However, DM patients were older, their HF duration was longer and their peak oxygen-uptake was lower (p < 0.005). During the 1st post-IA year in both groups there was a decrease in LV size and improvement in both LVEF and NYHA-class (p < 0.05). Post-IA 3-year HTx-free survival and prevalence of responders to IA in patients with and without DM was 81.3 ± 8% and 78.4 ± 8%, respectively and 73.3% and 67.7%, respectively. Post-IA 3-year freedom from β1-AAB reappearance in patients with and without DM reached 72.1 ± 9.0% and 71.1 ± 8.6%, respectively.


CONCLUSIONS
IA improves heart function, exercise tolerance and Tx-free survival in patients with DM-associated end-stage DCM. Our results also suggest that IA can delay HTx-listing, improve survival on HTx lists and even spare some diabetic patients from HTx, benefits of particular importance for these patients who are at high risk for pre-HTx and post-HTx mortality.
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany. Electronic address: dandel@dhzb.de.
Michael
M
Dandel
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
Angela
A
Englert
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
Gerd
G
Wallukat
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
Andrea
A
Riese
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
Christoph
C
Knosalla
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
Julia
J
Stein
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.
Roland
R
Hetzer
D000328:Adult; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016022:Case-Control Studies; D058065:Diabetic Cardiomyopathies / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D017079:Exercise Tolerance; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007163:Immunosorbent Techniques / Q000009:adverse effects / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018342:Receptors, Adrenergic, beta-1 / Q000276:immunology; D020127:Recovery of Function; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014850:Waiting Lists
C547787:ADRB1 protein, human; D001323:Autoantibodies; D015415:Biomarkers; D018342:Receptors, Adrenergic, beta-1
Autoantibodies; Cardiomyopathy; Diabetes; Immunoadsorption; β(1) receptors