Autoimmunity in Cardiomyopathy-Induced Heart Failure and Cardiac Autoantibody Removal by Immunoadsorption

Area of Science:

• Cardiology
• Immunology
• Internal Medicine

Background:

• Autoimmunity plays a role in cardiomyopathies, with β1-adrenoreceptor autoantibodies (β1AR-AAbs) implicated in disease progression.
• Dilated cardiomyopathy (DCM) with refractory heart failure (HF) can be associated with elevated β1AR-AAbs.

Purpose of the Study:

• To review the role of autoimmunity in cardiomyopathy etiopathogenesis.
• To focus on immunoadsorption (IA) therapy for β1AR-AAb-positive DCM patients with refractory HF.

Main Methods:

• Narrative review of existing literature.
• Analysis of studies on IA therapy efficacy in β1AR-AAb-positive DCM patients.

Main Results:

• Up to 97% of HF patients show increased β1AR-AAbs, correlating with HF severity.
• IA therapy effectively reduces β1AR-AAb levels in 84-91% of patients.
• Approximately 80% of patients respond to IA, showing improved left ventricular ejection fraction and cardiac output.

Conclusions:

• IA therapy is well-tolerated and can be repeated, even in elderly patients.
• IA offers significant long-term benefits, including improved survival rates for heart transplant candidates.
• IA therapy warrants greater consideration for appropriately selected β1AR-AAb-positive DCM patients.