Abstract 15444: Removal of Circulating Beta-1 Autoantibodies in Patients With Dilated Cardiomyopathy Can Improve Survival on Transplantation Lists and Spare Some Patients From Transplantation or Mechanical Circulatory Support
Background: With prolongation of waiting times for heart transplantatation (HTx) new therapies are needed to improve survival on HTx lists and to provide treatment alternatives for older persons who become less eligible for HTx. Patients with dilated cardiomyopathy (DCM) were often tested positive for β1-autoantibodies (β1-AABs) and their removal by immunoadsorption (IA) can improve cardiac function, but the usefulness of IA for end-stage heart failure therapy, especially in older patients with LVEF < 25%, is unknown. We assessed this aspect.
METHODS: Cardiac function and survival without HTx or ventricular assist device (VAD) support were evaluated in HTx candidates with dilated cardiomyopathy (DCM) and LVEF ≤ 25% who underwent unspecific IA (unselective antibody removal) in 7/1995 - 2/207 (follow-up 5.3 – 11.7 yrs). Before and after IA patients were tested for serum β1-autoantibodies (β1-AABs).
RESULTS: During the 1st year after IA the 82 β1-AAB positive patients who fulfilled all inclusion criteria showed improvement (p < 0.01) of both cardiac function (28.6% LVEF increase from 21 ± 4% to 27 ± 6%) and NYHA class. Only 7 patients (8.3%) needed VAD support. HTx/VAD-free survival of > 5 years was reached by 49 patients (59.8%). IA removed the β1-AABs in 81 patients (98.8%) and of these, 53 (65.4%) also fulfilled the “responder” criteria (LVEF increase with > 15%). The 53 responders showed an average 45% increase of LVEF (from 20 ± 4% to 29 ± 6%). The Benefits from IA were similar for patients below the age of 55 (n = 49; age 42 ± 8 yrs) and beyond this age (n = 33; age 59 ± 3 yrs). Redetection of β1-AABs (in 15 pts before and in 5 pts after the 5th post-IA year) coincided with cardiac worsening.
The 21 β1-AAB negative patients showed lower HTx/VAD-free survival in comparison with the β1-AAB positive patients (p < 0.01) and no LVEF (21 ± 4% vs. 22 ± 6%) or NYHA class improvement after IA.
CONCLUSION: Unspecific IA which effectively removes circulating β1-AABs is an efficient therapeutic option for β1-AAB positive DCM patients with LVEF ≤ 25% regardless their age. It can improve heart function allowing long-term stability which can delay HTx listing for many years and even spare patients from HTx or VAD insertion, benefits of particular importance for older patients who are at higher risk for HTx.
- © 2013 by American Heart Association, Inc.