Immunoadsorption in dilated cardiomyopathy: 6-month results from a randomized study.

Background: Various randomized studies evidenced that immunoadsorption (IA) repeated at monthly intervals induced acute and prolonged hemodynamic benefit in patients with severe heart failure due to dilated cardiomyopathy. Some findings indicate that the use of only one course of IA therapy may also induce prolonged beneficial effects.

Methods: This randomized study included 22 patients suffering from severe heart failure (left ventricular ejection fraction [LVEF] <35%) due to dilated cardiomyopathy. The first group (11 patients) was treated with four IA courses at monthly intervals. The second group (11 patients) received one IA course only without repetition. In all patients of the 2 groups, each course was performed in one IA session on 5 consecutive days. At 3 and 6 months after the beginning of this study, left ventricular function and hemodynamics were reevaluated in both groups.

Results: Immunoadsorption treatment repeated at monthly intervals induced improvement in LVEF after 6 months, that is, from 28.1% +/- 1.5% to 37.0% +/- 1.6% (+/-SEM; P < .01 vs baseline). Patients treated in only one IA course experienced comparable improvement of LVEF after 6 months, that is, from 26.5% +/- 2.2% to 34.8% +/- 2.9% (P < .01 vs baseline). In the group with repeated IA courses, cardiac index increased from baseline 2.2 +/- 0.1 to 2.8 +/- 0.2 L min(-1) m(-2) after 6 months (P < .01 vs baseline). In comparison, during the 6 months of this study in the group with one IA course, cardiac index increased from 2.1 +/- 0.1 to 2.7 +/- 0.2 L min(-1) m(-2). After 3 and 6 months, there were no significant differences between the 2 groups with respect to LVEF and all measured hemodynamic parameters.

Conclusions: One course of IA treatment may induce improvement of left ventricular function over a period of 6 months, with results comparable to those received by IA treatment repeated at monthly intervals.