CLINICAL STUDIES
Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy
Three-month results from a randomized study
Stephan B. Felix, MD*,
Alexander Staudt, MD*,
Wolf V. Dörffel, MD*,
Verena Stangl, MD*,
Kurt Merkel, MD ,
Manfred Pohl, PhD ,
Wolf D. Döcke, MD||,
Stanislao Morgera, MD,
Hans H. Neumayer, MD,
Klaus D. Wernecke, PhD¶,
Gerd Wallukat, PhD#,
Karl Stangl, MD* and
Gert Baumann, MD*
* Medizinische Klinik, Kardiologie Medizinische Klinik, Nephrologie Charité, Humboldt-Universtät zu Berlin, Berlin-Buch, Germany
Institut für Pathologie und Dermatohistologie, Diagnostisches Zentrum Berlin, Berlin-Buch, Germany
Institut für Medizinische Biophysik, Berlin-Buch, Germany
|| Immunologie, Berlin-Buch, Germany und
¶ Biometrie, Charité, Humboldt-Universtät zu Berlin, Berlin-Buch, Germany
# Max Delbrück Zentrum für Molekulare Medizin, Berlin-Buch, Germany
Manuscript received June 24, 1999;
revised manuscript received November 11, 1999,
accepted January 7, 2000.
Reprint requests and correspondence: Dr. Stephan B. Felix, Medizinische Klinik und Poliklinik Charité, Kardiologie, Campus Mitte, Humboldt-Universität zu Berlin, Schumannstr. 20-21, D-10098 Berlin, Germany
stephan.felix{at}charite.de
OBJECTIVES
The objective of our study was to assess the hemodynamic effects of immunoadsorption (IA) and subsequent immunoglobulin G (IgG) substitution in comparison with the effects of conventional medical treatment in patients with dilated cardiomyopathy (DCM).
BACKGROUND
Various circulating cardiac autoantibodies have been detected among patients suffering from DCM. These antibodies are extractable by IA.
METHODS
Patients with DCM (n = 18, New York Heart Association III–IV, left ventricular ejection fraction <30%) and who were on stable medication participated in the study. Hemodynamic measurements were performed using a Swan-Ganz thermodilution catheter. The patients were randomly assigned either to the treatment group with IA and subsequent IgG substitution (IA/IgG group, n = 9) or to the control group without IA/IgG (n = 9). In the IA/IgG group, the patients were initially treated in one IA session daily on three consecutive days. After the final IA session, 0.5 g/kg of polyclonal IgG was substituted. At one-month intervals, IA was then repeated for three further courses with one IA session daily on two consecutive days, until the third month.
RESULTS
After the first IA course and IgG substitution, cardiac index (CI) increased from 2.1 (±0.1) to 2.8 (±0.1) L/min/m2 (p < 0.01) and stroke volume index (SVI) increased from 27.8 (±2.3) to 36.2 (±2.5) ml/m2 (p < 0.01). Systemic vascular resistance (SVR) decreased from 1,428 (±74) to 997 (±55) dyne·s·cm–5 (p < 0.01). The improvement in CI, SVI and SVR persisted after three months. In contrast, hemodynamics did not change throughout the three months in the control group.
CONCLUSIONS
Immunoadsorption and subsequent IgG substitution improves cardiovascular function in DCM.
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Abbreviations and Acronyms
| | ACE | = angiotensin converting enzyme | | BPmean | = mean arterial blood pressure | | CI | = cardiac index | | DCM | = dilated cardiomyopathy | | HR | = heart rate | | IA | = immunoadsorption | | Ig | = immunoglobulin | | IgG | = immunoglobulin G | | IL | = interleukin | | LVEDD | = left ventricular end-diastolic diameter | | LVEF | = left ventricular ejection fraction | | NYHA | = New York Heart Association | | PAPmean | = mean pulmonary arterial pressure | | PCWP | = pulmonary capillary wedge pressure | | PVR | = pulmonary vascular resistance | | RAP | = right atrial pressure | | sIL-2R | = soluble IL-2 receptor | | sTNF-R1 and -R2 | = soluble tumor necrosis factor receptor I and II | | SVI | = stroke volume index | | SVR | = systemic vascular resistance | | TNFalpha | = tumor necrosis factor alpha |
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