Immunoadsorption with anti-IgG significantly increased cardiac index compared to protein A (3.0 vs 2.2 L/min/m2; P<0.01) and effectively eliminated IgG-3 autoantibodies in patients with DCM.
Case-Control (n=18)
Does immunoadsorption with anti-IgG improve hemodynamics and LVEF compared to protein A immunoadsorption in patients with dilated cardiomyopathy?
Removal of IgG-3 subclass autoantibodies via anti-IgG immunoadsorption significantly improves cardiac index and LVEF in patients with dilated cardiomyopathy compared to protein A immunoadsorption.
Absolute Event Rate: 3% vs 2.2%
p-value: p=<0.01
BACKGROUND: Immunoadsorption capable of removing circulating autoantibodies represents an additional therapeutic approach in dilated cardiomyopathy (DCM). The role played by autoantibodies belonging to the immunoglobulin (Ig) subclass G-3 in cardiac dysfunction remains to be elucidated. METHODS AND RESULTS: Patients with DCM (left ventricular ejection fraction 80%). IgG-3 was effectively eliminated only by anti-IgG adsorption (eg, during the first immunoadsorption course; protein A, -37+/-4%; anti-IgG, -89+/-3%; P<0.001 versus protein A). The beta1-receptor autoantibody was effectively reduced only by anti-IgG (P<0.01 versus protein A). Hemodynamics did not change in the protein A group. In the anti-IgG group during the first immunoadsorption course, cardiac index increased from 2.3+/-0.1 to 3.0+/-0.1 L x min(-1) x m(-2) (P<0.01 versus protein A). After 3 months, before the last immunoadsorption course, cardiac index was 2.2+/-0.1 L x min(-1) x m(-2) in the protein A group and 3.0+/-0.2 L x min(-1) x m(-2) in the anti-IgG group (P<0.01 versus protein A). Left ventricular ejection fraction increased only in the anti-IgG group (P<0.05 versus protein A). CONCLUSIONS: Autoantibodies belonging to IgG-3 may play an important role in cardiac dysfunction of DCM. The removal of antibodies of the IgG-3 subclass may represent an essential mechanism of immunoadsorption in DCM.
Staudt et al. (Mon,) conducted a case-control in Dilated cardiomyopathy (DCM) (n=18). Immunoadsorption with anti-IgG vs. Immunoadsorption with protein A was evaluated on Cardiac index at 3 months (p=<0.01). Immunoadsorption with anti-IgG significantly increased cardiac index compared to protein A (3.0 vs 2.2 L/min/m2; P<0.01) and effectively eliminated IgG-3 autoantibodies in patients with DCM.