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Myocardial Recovery in Patients With Systolic Heart Failure and Autoantibodies Against beta(1)-Adrenergic Receptors
Journal article   Open access   Peer reviewed

Myocardial Recovery in Patients With Systolic Heart Failure and Autoantibodies Against beta(1)-Adrenergic Receptors

Yuji Nagatomo, Dennis M. McNamara, Jeffrey D. Alexis, Leslie T. Cooper, G. William Dec, Daniel F. Pauly, Richard Sheppard, Randall C. Starling, W. H. Wilson Tang and IMAC-2 Investigators
Journal of the American College of Cardiology, Vol.69(8), pp.968-977
02/28/2017
DOI: 10.1016/j.jacc.2016.11.067
PMCID: PMC5330212
PMID: 28231950
url
https://doi.org/10.1016/j.jacc.2016.11.067View
Published (Version of record) Open Access

Abstract

BACKGROUND Among various cardiac autoantibodies (AAbs), those recognizing the beta(1)-adrenergic receptor (beta(1)AR) demonstrate agonist-like effects and induce myocardial damage that can be reversed by beta-blockers and immunoglobulin G3 (IgG3) immunoadsorption. OBJECTIVES The goal of this study was to investigate the role of beta(1)AR-AAbs belonging to the IgG3 subclass in patients with recent-onset cardiomyopathy. METHODS Peripheral blood samples were drawn at enrollment in patients with recent-onset cardiomyopathy (left ventricular ejection fraction [LVEF] <= 0.40; <6 months). The presence of IgG and IgG3-beta(1)AR-AAb was determined, and echocardiograms were assessed, at baseline and 6 months. Patients were followed up for <= 48 months. RESULTS Among the 353 patients who had blood samples adequate for the analysis, 62 (18%) were positive for IgG3-beta(1)AR-AAbs (IgG3 group), 58 (16%) were positive for IgG but not IgG3 (non-IgG3 group), and the remaining were negative. There were no significant differences in baseline systolic blood pressure, heart rate, or LVEF among the groups at baseline. Left ventricular end-diastolic and end-systolic diameters were significantly larger in the non-IgG3 group compared with the other groups (left ventricular end-diastolic diameter, p < 0.01; left ventricular end-systolic diameter, p = 0.03). At 6 months, LVEF was significantly higher in the IgG3 group (p = 0.007). Multiple regression analysis showed that IgG3-beta(1)AR-AAb was an independent predictor of LVEF at 6 months and change in LVEF over 6 months, even after multivariable adjustment (LVEF at 6 months, beta = 0.20, p = 0.01; change in LVEF, beta = 0.20, p = 0.008). In patients with high New York Heart Association functional class (III or IV) at baseline, the IgG3 group had a lower incidence of the composite endpoint of all-cause death, cardiac transplantation, and hospitalization due to heart failure, whereas the non-IgG3 group had the highest incidence of the composite endpoint. CONCLUSIONS IgG3-beta(1)AR-AAbs were associated with more favorable myocardial recovery in patients with recent-onset cardiomyopathy. (C) 2017 by the American College of Cardiology Foundation.
 Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology

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