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

Abstract

Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function and symptoms in patients with dilated cardiomyopathy. Biomarkers play an emerging role in disease monitoring and outcome prediction of heart failure (HF) patients. We aimed to analyze cardiac biomarkers as predictor for improvement of left ventricular (LV) function after immunoadsorption treatment in dilated cardiomyopathy (DCM). Thirty-one patients with dilated cardiomyopathy on optimized HF pharmacotherapy received a single cycle of immunoadsorption for five days followed by IVIG administration. Left ventricular ejection fraction (LVEF) and heart failure biomarkers (hs troponin T, hs troponin I, NT-proBNP and sST2) were evaluated before treatment, after the last cycle of immunoadsorption and during a median follow-up of 30.5 months. We correlated HF biomarkers before immunoadsorption and acute changes of HF biomarkers by immunoadsorption with LV improvement during the long-term follow-up. LV function improved significantly after immunoadsorption from 28.0 to 42.0% during the long-term follow-up (p < 0.0001). Evaluation of biomarker levels showed a significant decrease for hs troponin I (from 9.2 to 5.5 ng/L, p < 0.05) and NT-proBNP (from 789.6 to 281.2 pg/mL, p < 0.005). Correlation of biomarker levels before immunoadsorption and LVEF at the long-term follow-up show good results for hs troponin T (r = −0.40, r2 = 0.16, p < 0.05), hs troponin I (r = −0.41, r2 = 0.17, p < 0.05) and sST2 (r = −0.46, r2 = 0.19, p < 0.05). Correlation of biomarker levels before immunoadsorption and the individual increase in LV function was significant for hs troponin T (r = −0.52, r2 = 0.27, p < 0.005) and hs troponin I (r = −0.53, r2 = 0.29, p < 0.005). To imply a tool for monitoring outcome immediately after immunoadsorption treatment, we investigated the correlation of acute changes of biomarker levels by immunoadsorption treatment and individual increase in LV function. A drop in hs troponin T (r = −0.41, r2 = 0.17, p < 0.05) and hs troponin I (r = −0.53, r2 = 0.28, p < 0.005) levels demonstrate a good correlation to improvement in LVEF during the long-term follow-up. Conclusion: Hs troponin T and I levels correlate with LV function improvement during long-term follow-up. Acute decrease of troponins by immunoadsorption treatment is paralleled by individual improvement of LVEF at the long-term follow-up. Thus, troponins could serve as a monitoring tool for the improvement of LV function after immunoadsorption treatment in dilated cardiomyopathy.

Inflammatory cardiomyopathy: A review and meta-analysis of pathophysiology, diagnosis and clinical management

“…Fourteen studies evaluating the diagnosis and/or management of ICM formed the final dataset for analysis in the present meta-analysis [193][194][195][196][197][198][199][200][201][202][203][204][205][206]. Eight (8) of the studies were randomized prospective clinical trials [196,197,[199][200][201][202][203]206] and the remaining were non-randomized prospective or retrospective studies [193][194][195]198,204,205]. In total, the 14 studies enrolled 503 patients suspected with MC with cardiac involvement or ICM.…”

Immunoadsorption treatment for dilated cardiomyopathy

“…Overall, studies revealed beneficial effects of IA therapy in improving cardiac function and clinical outcomes in DCM patients. Recent studies have also shown that IA therapy can facilitate remodeling of left ventricle [23] …”

“…Recent studies have also shown that IA therapy can facilitate remodeling of left ventricle. [23] The main pathological character of DCM is the remodeling of cardiac chambers. Ventricular remodeling is a dynamic process.…”

Protein A Immunoadsorption Relieves Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy after Unsuccessful Methylprednisolone Treatment

“…First described in 1969, immunoadsorption (IA) has been widely utilized in the treatment of various neurological, cardiac, and rheumatological diseases [13][14][15]. In plasmapheresis, the plasma is discarded, whereas in IA, it is passed through an adsorption column that specifically depletes immunoglobulins and immune complexes [16].…”