Decreased oxidative stress in patients with idiopathic dilated cardiomyopathy one year after immunoglobulin adsorption

OBJECTIVES In a substudy to a recently reported investigation that demonstrated the benefit of immunoglobulin adsorption (immunoadsorption) for patients with idiopathic dilated cardiomyopathy (IDC), we tested whether this benefit is associated with a reduction of oxidative stress. BACKGROUND The progression of cardiomyopathy is believed to be related to the increase of oxidative stress. Therefore, reduction of oxidative stress could be one of the effects of immunoadsorption for improvement of cardiac performance and clinical status. METHODS Plasma markers for oxidative stress—thiobarbituric acid-reactive substances (TBARS), lipid peroxides (LPO), anti-oxidized low-density lipoprotein-autoantibodies (anti-oxLDL-AB), thiol groups and vitamin E—were compared in 31 patients, of whom 16 underwent immunoadsorption and 15 received conventional treatment (controls). All patients received a daily supplement of vitamins, minerals and trace elements. RESULTS After one year, TBARS (p = 0.026), LPO (p = 0.026) and anti-oxLDL-AB (p = 0.044) were decreased in the immunoadsorption group but not in the controls. Thiols were unchanged in the immunoadsorption group but were decreased in the controls (p = 0.001). Vitamin E accumulated in both groups (immunoadsorption: P = 0.001; controls: P = 0.031) with a trend for stronger accumulation after immunoadsorption (p = 0.09). Prior to the study, the anti-oxLDL-AB to left ventricular ejection fraction (LVEF) (p = 0.05) were inversely correlated. After one year, correlations with borderline significance were calculated for TBARS to New York Heart Association functional class (p = 0.081) and inversely for LPO to LVEF (p = 0.083). CONCLUSIONS Effective therapy in patients with IDC, such as immunoadsorption which improved cardiac performance and clinical status, is associated with a reduction of oxidative stress.