Abstract 9950: Immunoadsorption can Improve Cardiac Function in Transplant Candidates With Non-Ischemic Cardiomyopathy Associated With Diabetes Mellitus

Abstract

Background: Diabetes mellitus (DM) is a risk factor for death by heart failure (HF). With prolongation of waiting times for heart transplantatation (HTx) new therapies are necessary to improve survival. Diabetic patients are also less eligible for HTx and DM is a risk factor for death also after HTx. In dilated cardiomyopathy, immunoadsorption (IA) can improve heart function and delay HTx listing, but its usefulness for therapy of HF associated with DM is unknown. We assessed this aspect. Methods: Cardiac function and freedom from HF recurrence were evaluated in HTx candidates with non-ischemic chronic cardiomyopathy (NICCM) associated with DM who underwent IA in 6/2003-6/2012 (follow up 1–10 yrs). Non-diabetic NICCM patients referred for HTx in the same time period and who received the same IA served as controls. Before and after IA patients were tested for serum β 1 -autoantibodies (β 1 -AABs). Results: We evaluated 64 HF patients (32 with and 32 without DM). Before IA there were no differences between the 2 groups, neither in LV size and EF, nor in brain natriuretic peptide or β 1 -AAB levels. However, diabetic patients were older (51.5 ±7.0 vs. 44.2 ±12 yrs; p=0.005), their HF duration was longer (6.8 ±5 vs. 3.6 ±3 yrs; p<0.001) and their peak oxygen-uptake was lower (p=0.004). During the 1 st post-IA year in both groups there a decrease in LV size and improvement in both LVEF (from 26.4±7 to 31.3±7% and from 25.6±6 to 31.2±9%, respectively) and NYHA class (p<0.05 for all). Post-IA 3-year freedom from HF recurrence and prevalence of responders to IA in patients with and without DM reached 81.3±8% and 78.4±8%, respectively and 73.3% and 67.7%, respectively. Post-IA 3-year freedom from β 1 -AAB reappearance in patients with and without DM reached 72.1±9.0% and 71.1±8.6%, respectively. Conclusions: IA improves heart function and exercise tolerance in patients with end-stage NICCM, with and without additional DM. Responsiveness to IA and freedom from HF recurrence where similar in patients with and without DM, although DM patients were older and had longer duration of HF. IA appeared able to delay HTx listing, improve survival on HTx lists and even spare patients from HTx, benefits of particular importance for DM patients who are at higher risk for pre-HTx and post-HTx mortality.