Immunoadsorption therapy in refractory heart failure patients with dilated cardiomyopathy: a potential therapeutic option

Cavusoglu, Yuksel; Tahmazov, Senan; Murat, Selda; Akay, Olga Meltem

doi:10.1590/1806-9282.20220784

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Original Article • Rev. Assoc. Med. Bras. 69 (1) • 2023 • https://doi.org/10.1590/1806-9282.20220784 copy

Immunoadsorption therapy in refractory heart failure patients with dilated cardiomyopathy: a potential therapeutic option^* * Previous Presentation: Presented in part at the ESC Congress 2018, 25–29 August, Munich, Germany. European Heart Journal, Volume 39, Supp Special Edition, Page 796, Abstract Number: P3764, 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Removal of cardiac autoantibodies by immunoadsorption might confer clinical improvement in dilated cardiomyopathy. In this pilot study, we investigated the efficacy and safety of immunoadsorption therapy in refractory heart failure patients with dilated cardiomyopathy.

METHODS:

This study consisted of 9 heart failure patients with dilated cardiomyopathy, NYHA III-IV, left ventricular ejection fraction <30%, unresponsive to heart failure therapy, and with cardiac autoantibodies. Patients underwent immunoadsorption therapy for five consecutive days using a tryptophan column. Changes in cardiac function (left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter), exercise capacity (6-minute walk distance), neurohormonal (N-terminal pro-brain natriuretic peptide), proinflammatory (high-sensitive C-reactive protein), and myocardial (cardiac troponin-I), biochemical, and hematological variables were obtained at baseline and after 3 and 6 months of immunoadsorption therapy.

RESULTS:

Mean left ventricular ejection fraction and 6-minute walk distance significantly increased at 3 months (from 23.27±5.09 to 32.1±1.7%, p=0.01 for left ventricular ejection fraction and from 353±118 to 434±159 m, p=0.04 for 6-minute walk distance) and further increased at 6 months after immunoadsorption therapy (to 34.5±7.7%, p=0.02 for ejection fraction and to 441±136 m, p=0.04 for 6-minute walk distance). NT-proBNP level reduced from 1161(392.8–3034) to 385(116.1–656.5) ng/L (p=0.04), and high-sensitive C-reactive protein decreased from 9.74±0.96 to 4.3±5.8 mg/L (p=0.04) at 6 months. Left ventricular end-diastolic diameter (66.1±5.8 vs. 64.7±8.9 mm) and left ventricular end-systolic diameter (56.1±8.6 vs. 52.3±10.8 mm) tended to decrease but did not reach statistical significance. No significant worsening was observed in creatinine, cardiac troponin-I, and hemoglobin levels after the immunoadsorption procedure.

CONCLUSION:

In dilated cardiomyopathy patients with refractory heart failure, immunoadsorption may be considered a potentially useful therapeutic option to improve a patient's clinical status.

KEYWORDS:
Plasmapheresis; Heart failure; Cardiomyopathy, dilated

	Baseline	3-month FU	6-month FU	P
LVEF, %	23.27±5.09	32.1±1.7	34.5±7.7	0.02
LVEDD, mm	66.1±5.8	65.7±3.2	64.7±8.9	0.71
LVESD, mm	56.1±8.6	55.7±3.5	52.3±10.8	0.92
6MWD, m	353±118	434±159	441±136	0.04
NTproBNP, pg/mL	1161(392.8–3034)	846(399.5–883.5)	385(116.1–656.5)	0.04
hs-CRP, mg/L	10.1(1.85–14.7)	3.15(0.90–21.1)	1.82(0.82–7.85)	0.04
Troponin-I, ng/mL	0.02±0.03	0.008±0.003	0.005±0.001	0.36
CK-MB, ng/mL	1.62±0.63	2.1±1.06	1.84±0.41	0.20
Na, mEq/L	138±2.86	141±2.7	138±2.8	0.75
K, mEq/L	4.48±0.4	4.6±0.28	4.45±0.22	0.90
Creatinine, mg/dL	0.82±0.17	0.84±0.14	0.86±0.18	0.31
Hgb, g/dL	13.7±1.37	14.4±2	14.1±1.6	0.38
WBC, 10³/μL	8.30 (7.7–9.6)	7.8(7.4–9.15)	9.05(7.37–10.05)	0.32
Platelet count, 10³/μL	222 .0(193.0–235.5)	229.0±60.2	247.6±55.1	0.31

		Before the procedure	After the procedure	p
Body temperature, °C
	First session	36.2±0.27	36.3±0.55	0.8
	Second session	36.1±0.15	36.1±0.1	0.7
	Third session	36.5±0.41	36.3±0.45	0.02
	Fourth session	36.2±0.49	36.1±0.32	0.34
	Fifth session	36.3±0.5	36.3±0.44	1
Heart rate, bpm
	First session	77±15	79±8.5	0.66
	Second session	77±18	79±16	0.39
	Third session	77±16	77±16	0.91
	Fourth session	76±13	77±13	0.69
	Fifth session	86±18	83±15	0.7
Systolic BP, mm Hg
	First session	119±11.7	110±14.5	0.02
	Second session	113±13.8	116±9	0.63
	Third session	119±13.3	117±11.3	0.74
	Fourth session	114±18	119±19.2	0.48
	Fifth session	113±14.6	119±18.2	0.33
Diastolic BP, mm Hg
	First session	73.1±7.8	63.5±10.6	0.1
	Second session	66.5±8.6	66.6±10.7	0.94
	Third session	72.5±10.6	71.5±9.1	0.82
	Fourth session	67.6±10.9	74±12.3	0.28
	Fifth session	74±11	70.6±7.8	0.27

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[1] *
Previous Presentation: Presented in part at the ESC Congress 2018, 25–29 August, Munich, Germany. European Heart Journal, Volume 39, Supp Special Edition, Page 796, Abstract Number: P3764, 2018.

Age, years	44.1±7.8
Male gender, n (%)	5 (55.5)
Body mass index, kg/m²	32.2±9.6
Heart rate, bpm	74.2±15
Systolic BP, mm Hg	108.7±14.6
Diastolic BP, mm Hg	67.5±8.2
Diabetes, n (%)	2 (22.2)
Hypertension, n (%)	4 (44.4)
Smoking, n (%)	2 (22.2)
Atrial fibrillation, n (%)	3 (33.3)
LBBB/RBBB, n (%)	0 (0)
Anemia, n (%)	3 (33.3)
ASA, n (%)	1 (11.1)
Beta blocker, n (%)	9 (100)
RAAS inhibitors, n (%)	9 (100)
Spironolactone, n (%)	8 (88.9)
Loop diuretics, n (%)	9 (100)
Ivabradine, n (%)	4 (44.4)
Digoxin, n (%)	2 (22.2)
CRT, n (%)	0 (0)
ICD, n (%)	3 (33.3)