Apheresis in the treatment of idiopathic dilated cardiomyopathy

Dilated cardiomyopathy (DCM) causes significant morbidity and mortality and is the number one indication for cardiac transplantation in the United States. A large percentage of cases of DCM have no identifiable cause with evidence suggesting that these may represent an autoimmune disorder triggered by viral myocarditis. There is a growing body of literature suggesting that a number of immunoadsorption techniques, as well as plasma exchange, may have a role in the treatment of idiopathic DCM. The hypothesized autoimmune mechanism behind idiopathic DCM as well as the published evidence for the use of apheresis in this disorder are reviewed. The available evidence suggests that apheresis may be an effective treatment, but additional research is needed to identify markers that will predict response and the most effective apheresis technique.