DİLATE KARDİYOMİYOPATİ

Tanım: Dilate kardiyomiyopati ventriküler sistolik fonksiyonlarda bozukluk ile birlikte kardiyak büyüme ile karakterizedir. 

Gerekçe: Hastaların %80‘inde miyozin ağır zincir, β1 adrenerjik reseptör, mitokondrial antijenler, adenozin difosfat taşıyıcı protein, adenozin trifosfat taşıyıcı protein, M2 muskarinik reseptör, troponin I gibi miyokard antijenlerinden birine veya birkaçına karşı otoantikor(lar) mevcuttur. Bu antikorların çoğunlukla IgG3 tipinde olduğu bilinmektedir. 

İşlem: TPD, IA 

İşlenen Volüm: IA çalışmalarında belirtilmemiştir. Bir çalışmada hedef 5 L kabul edilmiştir. TPD için 1.5 TPH‘dir. 

Sıklığı: 

IA: çeşitli protokoller bulunmaktadır. Bunlar: 

ardışık 5 gün 5 işlem veya 

ardışık 3 gün 3 işlemi takiben 3 ay boyunca ayda 2 işlem veya 

4 ay boyunca her ay ardışık 5 gün 5 işlem. 

TPD: 5 işlem 

Replasman Sıvısı: TDP/albumin 

Uygulama sayı ve/veya süresi: Genel öneri ardışık 5 gün 5 işlem olmakla birlikte kardiyak fonksiyonları kötüleşen hastalarda tekrarlayan işlemler faydalıdır. IVIG kullanımı ardışık iĢlem seanslarının akabinde infeksiyon ihtimaline karşı değerlendirilmelidir. Ayrıca ardışık albümin ile yapılan işlemlerde, koagülasyon faktörlerinin azalması dikkate alınmalıdır. 

YARARLANILAN LİTERATÜRLER

 Christ T, Dobrev D, Wallukat G, Schuler S, Ravens U. Acute hemodynamic effects during immunoadsorption in patients with dilated cardiomyopathy positive for beta 1-adrenoceptor autoantibodies. Methods Find Exp Clin Pharmacol 2001;23:141–144. 

 Cooper LT, Jr. The natural history and role of immunoadsorption in dilated cardiomyopathy. J Clin Apher 2005;20:256–260. 

 Felix SB, Staudt A, Dorffel WV, Stangl V, Merkel K, Pohl M, Docke WD, Morgera S, Neumayer HH, Wernecke KD, Wallukat G, Stangl K, Baumann G. Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy: three-month results from a randomized study. J Am Coll Cardiol 2000;35:1590–1598. 

 Felix SB, Staudt A, Landsberger M, Grosse Y, Stangl V, Spielhagen T, Wallukat G, Wernecke KD, Baumann G, Stangl K. Removal of cardiodepressant antibodies in dilated cardiomyopathy by immunoadsorption. J Am Coll Cardiol 2002;39:646–652. 

 Mobini R, Maschke H, Waagstein F. New insights into the pathogenesis of dilated cardiomyopathy: possible underlying autoimmune mechanisms and therapy. Autoimmun Rev 2004;3:277–284. 

 Mobini R, Staudt A, Felix SB, Baumann G, Wallukat G, Deinum J, Svensson H, Hjalmarson A, Fu M. Hemodynamic improvement and removal of autoantibodies against beta1-ad renergic receptor by immunoadsorption therapy in dilated cardiomyopathy. J Autoimmun 2003;20:345–350. 

 Muller J, Wallukat G, Dandel M, Bieda H, Brandes K, Spiegelsberger S, Nissen E, Kunze R, Hetzer R. Immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy. Circulation 2000;101:385–391. 

 Staudt A, Bohm M, Knebel F, Grosse Y, Bischoff C, Hummel A, Dahm JB, Borges A, Jochmann N, Wernecke KD, Wallukat G, Baumann G, Felix SB. Potential role of 

autoantibodies belonging to the immunoglobulin G-3 subclass in cardiac dysfunction among patients with dilated cardiomyopathy. Circulation 2002;106:2448–2453. 

 Staudt A, Dorr M, Staudt Y, Bohm M, Probst M, Empen K, Plotz S, Maschke HE, Hummel A, Baumann G, Felix SB. Role of immunoglobulin G3 subclass in dilated cardiomyopathy: results from protein A immunoadsorption. Am Heart J 2005;150:729–736. 

 Staudt A, Schaper F, Stangl V, Plagemann A, Bohm M, Merkel K, Wallukat G, Wernecke KD, Stangl K, Baumann G, Felix SB. Immunohistological changes in dilated cardiomyopathy induced by immunoadsorption therapy and subsequent immunoglobulin substitution. Circulation 2001;103:2681–2686. 

 Dorffel WV, Felix SB, Wallukat G, Brehme S, Bestvater K, Hofmann T, Kleber FX, Baumann G, Reinke P. Short-term hemodynamic effects of immunoadsorption in dilated cardiomyopathy. Circulation 1997;95:1994–1997. 

 Dorffel WV, Wallukat G, Dorffel Y, Felix SB, Baumann G. Immunoadsorption in idiopathic dilated cardiomyopathy, a 3-year follow-up. Int J Cardiol 2004;97:529–534. 

 Staudt A, Staudt Y, Dorr M, Bohm M, Knebel F, Hummel A, Wunderle L, Tiburcy M, Wernecke KD, Baumann G, Felix SB. Potential role of humoral immunity in cardiac dysfunction of patients suffering from dilated cardiomyopathy. J Am Coll Cardiol 2004;44:829–836. 

 Staudt A, Hummel A, Ruppert J, Dorr M, Trimpert C, Birkenmeier K, Krieg T, Staudt Y, Felix SB. Immunoadsorption in dilated cardiomyopathy: 6-month results from a randomized study. Am Heart J 2006;152:712 e711–e716. 

 Sugiyama H, Hoshiai M, Sugita K, Matsuda K. Plasma exchange for removal of antibeta1-adrenergic receptor antibody in a small child with dilated cardiomyopathy. Pediatr Cardiol 2009;30:374–376. 

 Gesinde MO, Tan LB, Gooi HC. Plasma exchange treatment to reduce anti-beta1-adrenergic receptor antibody in a patient with dilated cardiomyopathy. J Clin Apher 2007;22:241–242. 

 Orrego CMD. Inflammation a potential target for therapeutic intervention in heart failure. Methodist Debakey Cardiovasc J 2009;5:8–11. 

 Nagatomo Y, Baba A, Ito H, Naito K, Yoshizawa A, Kurita Y, Nakamura I, Monkawa T, Matsubara T, Wakabayashi Y, Ogawa S, Akaishi M, Yoshikawa T. Specific immunoadsorption therapy using a tryptophan column in patients with refractory heart failure due to dilated cardiomyopathy. J Clin Apher 2011;26(1):1-8. 

 Baba A, Akaishi M, Shimada M, Monkawa T, Wakabayashi Y, Takahashi M, Nagatomo Y, Yoshikawa T. Complete elimination of cardiodepressant IgG3 autoantibodies by immunoadsorption in patients with severe heart failure. Circ J 2010;74(7):1372-8. 

 Ikeda U, Kasai H, Izawa A, Koyama J, Yazaki Y, Takahashi M, Higuchi M, Koh CS, Yamamoto K. Immunoadsorption therapy for patients with dilated cardiomyopathy and heart failure. Curr Cardiol Rev 2008;4(3):219-222. 

 Stephan B. Felix, Alexander Staudt, Non-specific immunoadsorption in patients with dilated cardiomyopathy: Mechanisms and clinical effects, International Journal of Cardiology, Volume 112, Issue 1, 10 September 2006, Pages 30-33, ISSN 0167-5273, 10.1016/j.ijcard.2006.05.014. 

 Staudt A, Hummel A, Ruppert J, Dörr M, Trimpert C, Birkenmeier K, Krieg T, Staudt Y, Felix SB. Immunoadsorption in dilated cardiomyopathy: 6-month results from a randomized study. Am Heart J. 2006;152(4):712.e1-6. 

 Felix SB, Staudt A, Dörffel WV, Stangl V, Merkel K, Pohl M, Döcke WD, Morgera S, Neumayer HH, Wernecke KD, Wallukat G, Stangl K, Baumann G. Hemodynamic 

effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy: three-month results from a randomized study. J Am Coll Cardiol 2000;35(6):1590-1598. 

 Müller J, Wallukat G, Dandel M, Bieda H, Brandes K, Spiegelsberger S, Nissen E, Kunze R, Hetzer R. Immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy. Circulation. 2000 Feb 1;101(4):385-391. 

 Staudt et al. (2001) Immunohistological changes in dilated cardiomyopathy induced by immunoadsorption therapy and subsequent immunoglobulin substitution. Circulation 103: 2681–2686. 

 Staudt et al. (2002) Potential role of autoantibodies belonging to the immunoglobulin G-3 subclass in cardiac dysfunction among patients with dilated cardiomyopathy. Circulation 106: 2448–2453 

 Dörffel et al. (2004) Immunoadsorption in idiopathic dilated cardiomyopathy, a 3-year follow-up. Int. J. Cardiol. 97(3): 529–534 

 Hessel et al. (2004) Economic evaluation and survival analysis of immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy. Eur. J. Health Econ. 5(1): 58–63 

 Knebel et al. (2004). Reduction of morbidity by immunoadsorption therapy in patients with dilated cardiomyopathy. Int. J. Cardiol. 97(3): 517–520 

 Jahns et al. (2004). Direct evidence for a beta 1-adrenergic receptor-directed autoimmune attack as a cause of idiopathic dilated cardiomyopathy. J. Clin. Invest. 113(10): 1419–1429. 

 Felix et al. (2000) Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy: three-month results from a randomized study. J. Am. Coll. Cardiol. 35: 1590–1598 

 Burgstaler EA, Cooper LT, Winters JL. Treatment of chronic dilated cardiomyopathy with immunoadsorption using the staphylococcal A-Agarose column: A comparison of immunoglobulin reduction using two different techniques. J Clin Apher 2007; 3 

 Cooper LT, Belohlavek M, Korinek J, Yoshifuku S, Sengupta PP, Burgstaler EA, Winters JL. A pilot study to assess the use of protein a immunoadsorption for chronic dilated cardiomyopathy. J Clin Apher 2007; 26 

 Mobini R, Maschke H, Waagstein F. New insights into the pathogenesis of dilated cardiomyopathy: possible underlying autoimmune mechanisms and therapy. Autoimmun Rev 2004; 3(4): 277-84 

 Staudt A, Dörr M, Staudt Y, Böhm M, Probst M, Empen K, Plötz S, Maschke HE, Hummel A, Baumann G, Felix SB. Role of immunoglobulin G3 subclass in dilated cardiomyopathy: results from protein A immunoadsorption. Am Heart J 2005; 150(4): 729-736. 

 Staudt A, Hummel A, Ruppert J, Dörr M, Trimpert C, Birkenmeier K, Krieg T, Staudt Y, Felix SB. Immunoadsorption in dilated cardiomyopathy: 6-month results from a randomized study. Am Heart J 2006; 152(4): 712.e1-6 

 Staudt A, Staudt Y, Hummel A, Empen K, Dörr M, Trimpert C, Birkenmeier K, Kühl U, Noutsias M, Russ D, Felix SB. Effects of immunoadsorption on the nt-BNP and nt-ANP plasma levels of patients suffering