Immunoadsorption
The use of this therapy is considered in ICMP with induced autoimmune reaction and with the production of anti-myocardial autoantibodies [24, 98, 99]. The principle of the therapy lies in the removal of circulating autoantibodies of IgG class circulating in peripheral blood [99]. Its efficiency has been already confirmed, however, just in small groups of patients [98]. Currently, a multicentric randomized study is taking place with the aim to verify the efficiency of the therapy in 200 patients with DCMP [152]. Already performed studies stated a favorable effect on cardiac function and on the decrease of NT-pro BNP levels in serum [153]. A study from 2009 did not prove the improvement of the LV EF, however, it described the improvement of the parameters from bicycle ergometry [153].
Interferons
Antiviral therapy with interferon beta proved in several studies a favorable effect on cardiac function and symptomatology of patients, however just in myocarditis cases caused by enteroviruses and adenoviruses [154, 156]. In a study from 2003, 22 patients were treated with subcutaneously administered interferon beta for 24 weeks whereas, in all of them, EMB proved the presence of enteroviruses or adenoviruses [154]. After 6 months, improvement of the heart function was observed in 14 patients and moreover, control EMB did not prove the presence of previously discovered viral agents in all of these patients. The fact that in 7 patients, there was observed no significant improvement of the heart function, was in some references and in the study, put in connection with a significant left ventricular dysfunction at the beginning of the therapy. Thus, the results in these patients could be influenced even by the extent of the inflammation, myocardial damage and by viral load in the myocardium and by the long-term duration of symptoms [23].
In 2009, there were published the results of a multicentric randomized and placebo-controlled study of 143 patients with chronic viral cardiomyopathy [155] and the detection of enteroviruses, adenoviruses or PBV19 in the myocardium, that supports in many respects the results of the study from 2003. In the group treated with interferon beta, there was observed an improvement of the heart function and even decrease of the viral load.
Author of the opening picture: Nevit Dilmen
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References:
23) SCHULTHEISS, Heinz-Peter, Uwe KÜHL a Leslie T. COOPER, JR. The management of myocarditis. European Heart Journal. 2011, 32(-), 2616–2625.
24) CAFORIO, A.L.P, PANKUWEIT S., ARBUSTINI E., et al. Current state knowledge on aetiology, diagnosis, management, and Therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease. European Heart Journal. 2013, 34(-), 2636–2648.
98) KINDERMANN, I. a et al. Update on Myocarditis. Journal of the American College of Cardiology. 2012, 59(9), 779-792.
99) KUCHYNKA, P. a et al. Myokarditida a zánětlivá kardiomyopatie. Kapitoly z kardiologie. 2013, 3(-), 87-91.
152) Multicenter Study of Immunoadsorption in Dilated Cardiomyopathy. Clinical Trials [online]. -: -, 2007 [cit. 2017-02-28].
153) DOESCH, A.O. a et al. Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy: Abstract. Journal of Clinical Apheresis [online]. 2009, 24(4), 141-149 [cit. 2017-02-28].
154) KÜHL, U. a et al. Interferon-β Treatment Eliminates Cardiotropic Viruses and Improves Left Ventricular Function in Patients With Myocardial Persistence of Viral Genomes and Left Ventricular Dysfunction. Circulation [online]. 2003, 107(22), 2793- [cit. 2017-02-28].
155) SCHULTHEISS, H.P. a et al. Late-Breaking Clinical Trial Abstracts From the American Heart Association’s Scientific Sessions 2008: The Effect of Subcutaneous Treatment with Interferon-Beta-1b Over 24 Weeks on Safety, Virus Elimination and Clinical Outcome in Patients with Chronic Viral Cardiomyopathy. 2008, 118(22), 2310-2317.
156) SCHMIDT-LUCKE, C. a et al. Interferon Beta Modulates Endothelial Damage in Patients with Cardiac Persistence of Human Parvovirus B19 Infection. The Journal of Infectious Diseases [online]. 2010, 201(6), 936-945 [cit. 2017-02-28].
