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Immunoadsorption can improve cardiac function in transplant candidates with non-ischemic dilated cardiomyopathy

Michael Dandel1, Angela Englert1, Gerd Wallukat1

  • 1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany.

Atherosclerosis. Supplements
|May 5, 2015
PubMed

Insights

Immunoadsorption (IA) improves heart function and survival for patients with diabetes and dilated cardiomyopathy (DCM). This therapy may reduce the need for heart transplantation (HTx) in high-risk diabetic patients.

Area of Science:

  • Cardiology
  • Immunology
  • Endocrinology

Background:

  • Diabetes mellitus (DM) increases mortality risk in patients with dilated cardiomyopathy (DCM), a condition often leading to heart failure (HF).
  • Diabetic patients face reduced eligibility and increased mortality risk associated with heart transplantation (HTx), necessitating alternative therapies.
  • Immunoadsorption (IA) shows potential for improving cardiac function in DCM, but its efficacy in DM-associated DCM requires investigation.

Purpose of the Study:

  • To assess the effectiveness of immunoadsorption (IA) in treating diabetic patients with end-stage dilated cardiomyopathy (DCM).
  • To compare cardiac function, exercise tolerance, and heart transplantation (HTx)-free survival between diabetic and non-diabetic DCM patients undergoing IA.

Main Methods:

  • Cardiac function and HTx-free survival were evaluated in diabetic DCM patients who underwent IA (Globaffin) between 2003-2012.
  • Non-diabetic DCM patients receiving IA during the same period served as controls.
  • Serum β1-autoantibodies (β1-AABs) were measured before and after IA in both groups.

Main Results:

  • IA treatment led to significant improvements in left ventricular (LV) size, ejection fraction (LVEF), and NYHA class within the first year for both diabetic and non-diabetic groups.
  • Three-year HTx-free survival rates were comparable between diabetic (81.3 ± 8%) and non-diabetic (78.4 ± 8%) patients post-IA.
  • The prevalence of responders to IA and freedom from β1-AAB reappearance were similar in both groups, suggesting IA's broad efficacy.

Conclusions:

  • Immunoadsorption (IA) effectively improves cardiac function, exercise tolerance, and heart transplantation (HTx)-free survival in diabetic patients with end-stage dilated cardiomyopathy (DCM).
  • IA therapy may help delay the need for HTx, improve outcomes for patients on waiting lists, and potentially spare some diabetic patients from transplantation.
  • These findings are particularly significant given the high pre- and post-HTx mortality risks associated with diabetes in DCM patients.
Abstract

Keywords:
AutoantibodiesCardiomyopathyDiabetesImmunoadsorptionβ(1) receptors

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