501: Efficacy of Immunoadsorbtion as Bridge-to-Transplant Therapy in Patients with Idiopathic Dilated Cardiomyopathy and Evidence of Beta-1 Adrenoceptor Autoantibodies

Role of β1-adrenoceptor autoantibodies in the pathogenesis of dilated cardiomyopathy

“…Thus, before IA there were no differences between "responders" and "non-responders" in the basic characteristics (LV size and function, past duration of HF, patient age and ␤ 1 -AAB levels) and after the last IA session all patients showed a reduction of ␤ 1 -AAB serum-levels below the 3 LU cut-off value (Dandel et al 2010a). Although after unspecific IA the ␤ 1 -AABs dropped significantly also in a patient control-group with pre-IA ␤ 1 -AAB levels below 3 LU, the prevalence of "responders" in this "low-level" ␤1-AAB group was only 31.6% and the probability for 5 year HTx/VAD-free survival reached only 47% (Dandel et al 2010b). These data suggest that the responsiveness to IA is related to the functional ␤ 1 -AAB levels and support our previous hypothesis that indeed the majority of patients with ␤ 1 -AAB levels below 3 LU will show no benefit from IA therapy .…”

“…In 17 DCM patients with effective ␤ 1 -AAB removal after unspecific IA performed on 5 consecutive days, Müller et al (2000) found no increase of ␤ 1 -AAB titers during the first post-IA year. In a long-term post-IA follow-up of 108 DCM patients with pre-IA serum levels >3 LU and post-IA serum levels <2 LU, re-appearance of relevant ␤ 1 -AAB levels (>3 LU) during the first 3 post-IA years was detected in 16 (14.8%) patients (Dandel et al 2010b). In 9 other patients, ␤ 1 -AABs reappeared after the 3rd post-IA year.…”

“…A recent evaluation of our 108 ␤ 1 -AAB positive DCM patients (pre-IA ␤ 1 -AAB serum levels >3 LU) with LVEF <30% who underwent unspecific IA between 1995 and 2010 revealed a 70.5% prevalence of "responders", i.e. patients with LVEF improvement of ≥20% of the pre-IA value in at least 2 of the 3 post-IA follow-up examinations performed at 3, 6 and 12 months (Dandel et al 2010b). Only 3 "non-responders" showed no relevant reduction of ␤ 1 -AAB serum levels after IA and these patients also showed no improvement of cardiac function.…”

“…In a prospective study aimed to compare the results of different types of IA in DCM patients with functional ␤ 1 -AAB levels above 3 LU, specific IA (selective ␤ 1 -AAB removal) and unspecific IA (unselective IgG removal) showed similar efficacy in ␤1-AAB removal (Dandel et al 2010b). The ␤ 1 -AAB levels dropped after both IA techniques by more than 82%.…”

Apheresis in the treatment of idiopathic dilated cardiomyopathy

“…A single controlled trial has been published in abstract form comparing the β1‐adrenoreceptor antibody column to the SPAA column [51]. In this study, 54 DCM patients treated with SPAA were compared to 51 patients treated with β1‐adrenoreceptor antibody column.…”