Effects of immunoadsorption and subsequent immunoglobulin G substitution on cardiopulmonary exercise capacity in patients with dilated cardiomyopathy - 05/08/11
, Christiane Trimpert, PhD a, Ute Nauke, MD a, Martin Landsberger, PhD a, Astrid Hummel, MD a, Daniel Beug, MD a, Arne Kieback, MD a, Marcus Dörr, MD a, Klaus Empen, MD a, Fabian Knebel, MD b, Ralf Ewert, MD a, Aniela Angelow, MD c, Wolfgang Hoffmann, MD, MPH c, Stephan B. Felix, MD a, Alexander Staudt, MD aRésumé |
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 (VE/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.
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Vol 159 - N° 5
P. 809-816 - mai 2010 Retour au numéro
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