Short-term Hemodynamic Effects of Immunoadsorption in Dilated Cardiomyopathy

Abstract

Background Previous studies have shown that the sera of many patients with dilated cardiomyopathy (DCM) are positive for several antibodies directed against cardiac antigens. Anti–β 1 -adrenergic receptor antibodies occur in 70% to 90% of DCM patients. These antibodies are extractable by immunoadsorption (IA). In an investigation of the functional significance of antibodies for hemodynamics, IA was performed throughout 5 consecutive days on nine patients with severe DCM who were on stable drug therapy. Methods and Results Immunoglobulins were eliminated in nine patients with severe DCM (mean age, 43.5 years; range, 25 to 58 years; left ventricular ejection fraction, <25%). IA was performed over 5 consecutive days with an immunoadsorber for immunoglobulin. All patients were on stable medication, including ACE inhibitors, digitalis, and diuretics. All patients received β-blockers. During therapy, hemodynamic parameters (mean±SD) were monitored with a Swan-Ganz thermodilution catheter. IA elicited a decrease of anti–β 1 -adrenergic receptor antibodies from 6.4±1.3 to 1.0±0.5 relative units. During IA, cardiac output increased from 3.7±0.8 to 5.5±1.8 L/min, P <.01. Mean arterial pressure decreased from 76.0±9.9 to 65.0±11.2 mm Hg, P <.05; mean pulmonary arterial pressure, from 27.6±7.7 to 22.0±6.5 mm Hg, P <.05; left ventricular filling pressure, from 16.8±7.4 to 12.8±4.7 mm Hg, P <.05; and systemic vascular resistance, from 1465±332 to 949±351 dyne·s·cm −5 , P <.01. Conclusions In addition to conventional medical treatment, IA may be an additional therapeutic possibility for acute hemodynamic stabilization of patients with severe DCM.