Short-term Hemodynamic Effects of Immunoadsorption in Dilated Cardiomyopathy

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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, 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.