Effects of immunoadsorption and subsequent immunoglobulin G substitution on cardiopulmonary exercise capacity in patients with dilated cardiomyopathy

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• 作者：Lars R. Herda ; Christiane Trimpert ; Ute Nauke ; Martin L ; sberger ; Astrid Hummel ; Daniel Beug ; Arne Kieback ; Marcus Dö ; rr ; Klaus Empen ; Fabian Knebel ; Ralf Ewert ; Aniela Angelow ; Wolfgang Hoffmann
• 刊名：American Heart Journal
• 出版年：2010
• 出版时间：May 2010
• 年：2010
• 卷：159
• 期：5
• 页码：809-816
• 全文大小：437 K

文摘

Background

Recent data indicate that cardiac antibodies play an active role in the pathogenesis of dilated cardiomyopathy (DCM) and may contribute to cardiac dysfunction in patients with DCM. The present study investigated the influence of immunoadsorption with subsequent immunoglobulin G substitution (IA/IgG) on cardiopulmonary exercise capacity in patients with DCM.

Methods

Sixty patients with DCM (New York Heart Association II-IV, left ventricular ejection fraction ≤45 % ) were included in this single-center university hospital–based case-control study. Patients either were treated with IA/IgG (n = 30) or were followed without IA/IgG (n = 30). At baseline and after 3 months, we compared echocardiographic assessment of left ventricular function and spiroergometric exercise parameters.

Results

In contrast to controls, left ventricular ejection fraction improved significantly in the IA/IgG group from 33.0 % ± 1.2 % to 40.1 % ± 1.5 % (P < .001). In the control group, spiroergometric exercise parameters did not change during follow-up. After 3 months, maximum achieved power increased in the treatment group from 114.2 ± 7.4 to 141.9 ± 7.9 W (P = .02). Total exercise time increased in the treatment group from 812 ± 29 to 919 ± 30 seconds (P < .05). Peak oxygen uptake (Vo₂) increased from 17.3 ± 0.9 to 21.8 ± 1.0 mL min⁻¹ kg⁻¹ after IA/IgG (P < .01). Oxygen pulse (peak Vo₂/maximum heart rate) increased in the treatment group (10.7 ± 0.7 vs 13.6 ± 0.7 mL beat⁻¹ min⁻¹, P < .01). The Vo₂ at the gas exchange anaerobic threshold increased after 3 months in the treatment group from 10.3 ± 0.5 to 13.2 ± 0.5 mL min⁻¹ kg⁻¹ (P < .001). The ventilatory response to exercise (V_E/Vco₂ slope) decreased after IA/IgG therapy from 32.3 ± 1.5 to 28.7 ± 0.9 (P = .02).

Conclusions

In patients with DCM, IA/IgG therapy may induce improvement in echocardiographic and cardiopulmonary exercise parameters.