Injections helped patients avoid heart transplants
Nine patients awaiting heart transplants at the University of Pittsburgh had some good news about a year ago. They received injections of immune globulin instead and recovered without having to go the more radical route. After infusions of high-dose, 2 g/kg, immune globulin were injected, they improved and one year later had attained New York Heart Association (NYHA) class I or II heart failure. None have been rehospitalized for congestive heart failure in the 20 months since the study concluded.
The patients had been hospitalized with acute dilated cardiomyopathy NYHA class III to IV heart failure and left ventricular ejection fraction of less than 0.40. Each had been symptomatic for less than six months.
Only 25% of a comparable group of 72 patients waiting for transplants and treated conventionally improved to a point where they could be removed from the list.
"This report on immune globulin therapy is preliminary," says Dennis M. McNamara, MD, director of the cardiomyopathy clinic at the University of Pittsburgh and head of the research project. "It’s too soon to say that it’s a breakthrough. We’ve started a large randomized clinical trial to see if what we saw in this small group of patients can be replicated with appropriate controls. Enrollment should be finished by fall this year, and we anticipate preliminary results by mid-1998."
"Transplantation is an expensive technology," continues McNamara, "so this medical therapy would represent a great savings."
The immune globulin therapy costs $3,000 to $5,000. Heart transplantation the operation and first year of care including 10 to 15 biopsies can cost $150,000 to $200,000.
This is the first time immune globulin has been used for acute cardiomyopathy in adults. A form of heart inflammation in children has been treated with the agent.
Suggested reading
McNamara DM, Rosenblum WD, Janosko KM, et al. Intravenous immune globulin in the therapy of myocarditis and acute cardiomyopathy. Circulation 1997; 95:2,476-2,478.
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