Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy - Three-month results from a randomized study

OBJECTIVE 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 patien ts with dilated cardiomyopathy (DCM). BACKGROUND Various circulating cardiac autoantibodies have been detected am ong patients suffering from DCM. These antibodies are extractable by IA. METHODS Patients with DCM (n = 18, Nem York Heart Association III-IV, left ventricular ejection fraction <30%) and who were on stable medication parti cipated in the study. Hemodynamic measurements were performed using a Swan- Ganz thermodilution catheter. The patients were randomly assigned either to the treatment group with LA 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 cons ecutive days. After the final IA session, 0.5 g/kg of polyclonal IgG was su bstituted. At one-month intervals, IA was then repeated for three further c ourses with one LA session daily on two consecutive days, until the third m onth. 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/m(2) (p < 0.01) and strok e volume index (SVI) increased from 27.8 (+/-2.3) to 36.2 (+/-2.5) ml/m(2) (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 SV R persisted after three months. In contrast, hemodynamics did not change th roughout the three months in the control group. CONCLUSIONS Immunoadsorption and subsequent IgG substitution improves cardi ovascular function in DCM. (C) 2000 by the American College of Cardiology.