SHORT-TERM HEMODYNAMIC-EFFECTS OF IMMUNOADSORPTION IN DILATED CARDIOMYOPATHY

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-beta(1)-adrenergic receptor an tibodies occur in 70% to 90% of DCM patients. These antibodies are ext ractable by immunoadsorption (IA). In an investigation of the function al significance of antibodies for hemodynamics, IA was performed throu ghout 5 consecutive days on nine patients with severe DCM who were on stable drug therapy. Methods and Results Immunoglobulins were eliminat ed in nine patients with severe DCM (mean age, 43.5 years; range, 25 t o 58 years; left ventricular ejection fraction, <25%). IA was performe d over 5 consecutive days with an immunoadsorber for immunoglobulin. A ll patients were on stable medication, including ACE inhibitors, digit alis, and diuretics. All patients received beta-blockers. During thera py, hemodynamic parameters (mean+/-SD) were monitored with a Swan-Ganz thermodilution catheter. IA elicited a decrease of anti-beta(1)-adren ergic 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 arteria! pressure, from 27.6+/-7.7 to 2 2.0+/-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, fro m 1465+/-332 to 949+/-351 dyne . s . cm(-5), P<.01. Conclusions In add ition to conventional medical treatment, LA may be an additional thera peutic possibility for acute hemodynamic stabilization of patients wit h severe DCM.