Add-on Immunoadsorption Shortly-after Optimal Medical Treatment Further Significantly and Persistently Improves Cardiac Function and Symptoms in Recent-Onset Heart Failure—A Single Center Experience

Abstract

Background: Immunoadsorption and intravenous immunoglobulin (IVIG) administration may have beneficial effects in patients with dilated cardiomyopathy with end-stage heart failure. We investigated the effect of immunoadsorption with subsequent IVIG administration on cardiac function and symptoms in patients on optimal medical treatment (OMT) for heart failure (HF) with recent-onset cardiomyopathy during long-term follow-up. Methods: Thirty-five patients with recent-onset of HF symptoms received intensive guideline-recommended medical HF therapy for 5.2 months. Subsequently, all patients received a single cycle of immunoadsorption for five days followed by IVIG administration. During the 29-month follow-up period, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and N-terminal pro brain natriuretic peptide (NT-proBNP) were evaluated. Changes in quality of life (QoL) were assessed using the Minnesota Living with HF Questionnaire. Results: Three months after immunoadsorption, NYHA functional class improved from 2.0 to 1.5 (p < 0.005) and LVEF significantly increased from 27.0% to 39.0% (p < 0.0001). Long-term follow-up of 29 months showed stable NYHA functional class and a further moderate increase in LVEF from 39.0% to 42.0% (p < 0.0001) accompanied by a significant improvement in NT-proBNP and QoL scores. Conclusion: Immunoadsorption followed by IVIG administration further enhances LVEF, HF symptoms, QoL and biomarkers in patients with recent-onset HF on OMT.

Use of Cardiac Biomarkers for Monitoring Improvement of Left Ventricular Function by Immunoadsorption Treatment in Dilated Cardiomyopathy

“…After the immunoadsorption treatment, LVEF improved significantly and LV diameters decreased in the course of LV reverse remodeling. These findings have been described before in some small observational studies [1,2,4,8,9] and immunoadsorption treatment has been added as an aetiology-related therapeutic option in the DCM to the latest position paper of the European Society of Cardiology [41].…”

“…Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function in dilated cardiomyopathy (DCM) and end-stage heart failure (HF) [1,2,3,4,5,6,7,8,9]. DCM is a heterogeneous disease entity associated with genetic predisposition, cardiac infection, and inflammation [1].…”

“…DCM is a heterogeneous disease entity associated with genetic predisposition, cardiac infection, and inflammation [1]. Antibodies against cardiac structures are part of an auto-inflammatory process promoting auto-immune mediated myocardial damage [9,10,11,12,13]. Addressing these pathological mechanisms, Dörffel et al described twenty years ago for the first time the beneficial hemodynamic effects of immunoadsorption in DCM by an unselective extraction of IgG [14], followed by several small studies investigating the effects of immunoadsorption treatment in DCM [1,2,4,7,8,15,16].…”

“…Immunoadsorption therapy has already been proven in many auto-immune mediated diseases such as granulomatosis with polyangiitis, and Guillain-Barre Syndrome, and, due to its causal therapeutic approach, became part of the standard care [17]. We previously showed that a single-cycle immunoadsorption in combination with subsequent IVIG substitution in patients diagnosed with recent-onset HF leads to a long-term improvement of symptoms, cardiac function, natriuretic peptide levels, and quality of life [9].…”

Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology

“…In biopsy‐proven chronic enteroviral or adenoviral and/or Parvovirus B19 positive DCM, an immunomodulatory treatment with interferon beta has been recently shown to reduce viral load and improve functional capacity . Small open‐label controlled, or observational studies suggested that removal of circulating antibodies in DCM by immunoadsorption, followed by IgG substitution, resulted in improvement in cardiac function, symptom relief and increased exercise tolerance . At present, immunoadsorption is considered as an experimental treatment option that requires further evaluation in outcome trials.…”