TY - JOUR
T1 - Myocardial Recovery in Patients With Systolic Heart Failure and Autoantibodies Against β1-Adrenergic Receptors
AU - Nagatomo, Yuji
AU - McNamara, Dennis M.
AU - Alexis, Jeffrey D.
AU - Cooper, Leslie T.
AU - Dec, G. William
AU - Pauly, Daniel F.
AU - Sheppard, Richard
AU - Starling, Randall C.
AU - Tang, W. H.Wilson
AU - Janosko, Karen
AU - McTiernan, Charles
AU - London, Barry
AU - Hanley-Yanez, Karen
AU - Gorcsan, John
AU - Tanaka, Hidekazu
AU - Suffoletto, Mathew
AU - Oblak, Cynthia
AU - McNallan, Annette
AU - Koenig, Lu Anne
AU - Mather, Paul
AU - Pierson, Natalie
AU - Rubin, Sharon
AU - Bell, Yanique
AU - Ervin, Alicia
AU - Boehmer, John
AU - Frey, Patricia
AU - Alexis, Jeffrey
AU - Schrack, Janice
AU - LaDuke, Pam
AU - Torre-Amione, Guillermo
AU - Arredondo, Jeannie
AU - Smith, Pamela C.
AU - Fuoco, Stephanie
AU - Wittstein, Ilan S.
AU - Breton, Elayne
AU - Thohan, Vinay
AU - Wesley, Deborah
AU - Cocca-Spofford, Diane
AU - Markham, David W.
AU - Fernandez, Lynn
AU - Debes, Colleen
AU - Zucker, Mark J.
AU - Adams, Laura
AU - Liu, Peter
AU - Renton, Judith
AU - Narula, Jagat
AU - Allen, Byron
AU - Westberg, Elizabeth
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/2/28
Y1 - 2017/2/28
N2 - Background Among various cardiac autoantibodies (AAbs), those recognizing the β1-adrenergic receptor (β1AR) demonstrate agonist-like effects and induce myocardial damage that can be reversed by β-blockers and immunoglobulin G3 (IgG3) immunoadsorption. Objectives The goal of this study was to investigate the role of β1AR-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-β1AR-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-β1AR-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-β1AR-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, β = 0.20, p = 0.01; change in LVEF, β = 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-β1AR-AAbs were associated with more favorable myocardial recovery in patients with recent-onset cardiomyopathy.
AB - Background Among various cardiac autoantibodies (AAbs), those recognizing the β1-adrenergic receptor (β1AR) demonstrate agonist-like effects and induce myocardial damage that can be reversed by β-blockers and immunoglobulin G3 (IgG3) immunoadsorption. Objectives The goal of this study was to investigate the role of β1AR-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-β1AR-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-β1AR-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-β1AR-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, β = 0.20, p = 0.01; change in LVEF, β = 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-β1AR-AAbs were associated with more favorable myocardial recovery in patients with recent-onset cardiomyopathy.
KW - IgG3
KW - autoantibody
KW - recent-onset cardiomyopathy
KW - β-blocker
UR - https://www.scopus.com/pages/publications/85013296223
U2 - 10.1016/j.jacc.2016.11.067
DO - 10.1016/j.jacc.2016.11.067
M3 - Article
C2 - 28231950
AN - SCOPUS:85013296223
SN - 0735-1097
VL - 69
SP - 968
EP - 977
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -