A pilot study to assess the use of protein a immunoadsorption for chronic dilated cardiomyopathy

Leslie T Jr. Cooper, Marek Belohlavek, Josef Korinek, Shiro Yoshifuku, Partho P. Sengupta, Edwin A. Burgstaler, Jeffrey L. Winters

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Dilated cardiomyopathy (DCM) is a leading cause of end-stage heart failure and cardiac transplantation. Anticardiac antibodies are common and removal of these through immunoadsorption (IA) is associated with improvement in global cardiac function. The effect of IA on regional function and quality of life (QOL) without intravenous immunoglobulin (IVIG) substitution has not been described. We performed a pilot trial using Immunosorba® columns in four patients with chronic DCM and NYHA Class II-III congestive heart failure. Subjects were followed for 6 months with serial echocardiograms and validated QOL assessments. Regional and global left ventricular (LV) end-systolic deformations were assessed by two-dimensional strain echocardiography. Total IgG decreased 95% (from 1,210 ± 274 mg/dl to 57 ± 16 mg/dl, P = 0.003) and IgG3 decreased 61% (from 33 ± 16 mg/dl to 13 ± 7 mg/dl, P = 0.024). QOL improved from baseline to 6 months as assessed by the Living with Heart Failure questionnaire (from 54 ± 18 to 19 ± 7, P = 0.029). Mean LV ejection fraction improved from 35 to 40% at Day 5 and to 44% at 6 months (P = NS). The LV end diastolic and end systolic volumes decreased (220-202 ml, 159-130 ml, P = NS) at 6 months. Global end-systolic strain improved from -7.3% at baseline to -8.5% at Day 5 and 8.8% at 6 months (P = NS). Regional LV function and response to IA was not uniform. Even without IVIG substitution, IA for the treatment of chronic DCM is associated with improved QOL up to 6 months after treatment. A randomized, sham-controlled trial is required to confirm the benefits of IA for DCM.

Original languageEnglish (US)
Pages (from-to)210-214
Number of pages5
JournalJournal of Clinical Apheresis
Volume22
Issue number4
DOIs
StatePublished - 2007

Fingerprint

Dilated Cardiomyopathy
Quality of Life
Heart Failure
Intravenous Immunoglobulins
Heart Transplantation
Proteins
Immunoglobulin G
Left Ventricular Function
Stroke Volume
Echocardiography
Randomized Controlled Trials
Antibodies
Therapeutics

Keywords

  • Anticardiac antibodies
  • Dilated cardiomyopathy
  • Immunoadsorption
  • Myocarditis

ASJC Scopus subject areas

  • Hematology

Cite this

A pilot study to assess the use of protein a immunoadsorption for chronic dilated cardiomyopathy. / Cooper, Leslie T Jr.; Belohlavek, Marek; Korinek, Josef; Yoshifuku, Shiro; Sengupta, Partho P.; Burgstaler, Edwin A.; Winters, Jeffrey L.

In: Journal of Clinical Apheresis, Vol. 22, No. 4, 2007, p. 210-214.

Research output: Contribution to journalArticle

Cooper, Leslie T Jr. ; Belohlavek, Marek ; Korinek, Josef ; Yoshifuku, Shiro ; Sengupta, Partho P. ; Burgstaler, Edwin A. ; Winters, Jeffrey L. / A pilot study to assess the use of protein a immunoadsorption for chronic dilated cardiomyopathy. In: Journal of Clinical Apheresis. 2007 ; Vol. 22, No. 4. pp. 210-214.
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abstract = "Dilated cardiomyopathy (DCM) is a leading cause of end-stage heart failure and cardiac transplantation. Anticardiac antibodies are common and removal of these through immunoadsorption (IA) is associated with improvement in global cardiac function. The effect of IA on regional function and quality of life (QOL) without intravenous immunoglobulin (IVIG) substitution has not been described. We performed a pilot trial using Immunosorba{\circledR} columns in four patients with chronic DCM and NYHA Class II-III congestive heart failure. Subjects were followed for 6 months with serial echocardiograms and validated QOL assessments. Regional and global left ventricular (LV) end-systolic deformations were assessed by two-dimensional strain echocardiography. Total IgG decreased 95{\%} (from 1,210 ± 274 mg/dl to 57 ± 16 mg/dl, P = 0.003) and IgG3 decreased 61{\%} (from 33 ± 16 mg/dl to 13 ± 7 mg/dl, P = 0.024). QOL improved from baseline to 6 months as assessed by the Living with Heart Failure questionnaire (from 54 ± 18 to 19 ± 7, P = 0.029). Mean LV ejection fraction improved from 35 to 40{\%} at Day 5 and to 44{\%} at 6 months (P = NS). The LV end diastolic and end systolic volumes decreased (220-202 ml, 159-130 ml, P = NS) at 6 months. Global end-systolic strain improved from -7.3{\%} at baseline to -8.5{\%} at Day 5 and 8.8{\%} at 6 months (P = NS). Regional LV function and response to IA was not uniform. Even without IVIG substitution, IA for the treatment of chronic DCM is associated with improved QOL up to 6 months after treatment. A randomized, sham-controlled trial is required to confirm the benefits of IA for DCM.",
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