Abstract
Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function and symptoms in patients with dilated cardiomyopathy. Biomarkers play an emerging role in disease monitoring and outcome prediction of heart failure (HF) patients. We aimed to analyze cardiac biomarkers as predictor for improvement of left ventricular (LV) function after immunoadsorption treatment in dilated cardiomyopathy (DCM). Thirty-one patients with dilated cardiomyopathy on optimized HF pharmacotherapy received a single cycle of immunoadsorption for five days followed by IVIG administration. Left ventricular ejection fraction (LVEF) and heart failure biomarkers (hs troponin T, hs troponin I, NT-proBNP and sST2) were evaluated before treatment, after the last cycle of immunoadsorption and during a median follow-up of 30.5 months. We correlated HF biomarkers before immunoadsorption and acute changes of HF biomarkers by immunoadsorption with LV improvement during the long-term follow-up. LV function improved significantly after immunoadsorption from 28.0 to 42.0% during the long-term follow-up (p < 0.0001). Evaluation of biomarker levels showed a significant decrease for hs troponin I (from 9.2 to 5.5 ng/L, p < 0.05) and NT-proBNP (from 789.6 to 281.2 pg/mL, p < 0.005). Correlation of biomarker levels before immunoadsorption and LVEF at the long-term follow-up show good results for hs troponin T (r = −0.40, r2 = 0.16, p < 0.05), hs troponin I (r = −0.41, r2 = 0.17, p < 0.05) and sST2 (r = −0.46, r2 = 0.19, p < 0.05). Correlation of biomarker levels before immunoadsorption and the individual increase in LV function was significant for hs troponin T (r = −0.52, r2 = 0.27, p < 0.005) and hs troponin I (r = −0.53, r2 = 0.29, p < 0.005). To imply a tool for monitoring outcome immediately after immunoadsorption treatment, we investigated the correlation of acute changes of biomarker levels by immunoadsorption treatment and individual increase in LV function. A drop in hs troponin T (r = −0.41, r2 = 0.17, p < 0.05) and hs troponin I (r = −0.53, r2 = 0.28, p < 0.005) levels demonstrate a good correlation to improvement in LVEF during the long-term follow-up. Conclusion: Hs troponin T and I levels correlate with LV function improvement during long-term follow-up. Acute decrease of troponins by immunoadsorption treatment is paralleled by individual improvement of LVEF at the long-term follow-up. Thus, troponins could serve as a monitoring tool for the improvement of LV function after immunoadsorption treatment in dilated cardiomyopathy.
Highlights
Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function in dilated cardiomyopathy (DCM) and end-stage heartBiomolecules 2019, 9, 654; doi:10.3390/biom9110654 www.mdpi.com/journal/biomoleculesBiomolecules 2019, 9, 654 failure (HF) [1,2,3,4,5,6,7,8,9]
We previously showed that a single-cycle immunoadsorption in combination with subsequent IVIG substitution in patients diagnosed with recent-onset heart failure (HF) leads to a long-term improvement of symptoms, cardiac function, natriuretic peptide levels, and quality of life [9]
We investigated the correlation of HF biomarkers with Left ventricular ejection fraction (LVEF) improvement after a median of 30.5 months follow-up in patients that received immunoadsorption treatment
Summary
Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function in dilated cardiomyopathy (DCM) and end-stage heartBiomolecules 2019, 9, 654; doi:10.3390/biom9110654 www.mdpi.com/journal/biomoleculesBiomolecules 2019, 9, 654 failure (HF) [1,2,3,4,5,6,7,8,9]. Antibodies against cardiac structures are part of an auto-inflammatory process promoting auto-immune mediated myocardial damage [9,10,11,12,13]. Addressing these pathological mechanisms, Dörffel et al described twenty years ago for the first time the beneficial hemodynamic effects of immunoadsorption in DCM by an unselective extraction of IgG [14], followed by several small studies investigating the effects of immunoadsorption treatment in DCM [1,2,4,7,8,15,16]. We previously showed that a single-cycle immunoadsorption in combination with subsequent IVIG substitution in patients diagnosed with recent-onset HF leads to a long-term improvement of symptoms, cardiac function, natriuretic peptide levels, and quality of life [9]
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