Myocardial Recovery in Patients With Systolic Heart Failure and Autoantibodies Against β(1)-Adrenergic Receptors.
Myocardial Recovery in Patients With Systolic Heart Failure and Autoantibodies Against β(1)-Adrenergic Receptors.
复制标题
收缩性心力衰竭和抗 β(1)-肾上腺素能受体自身抗体患者的心肌恢复。
DOI：
10.1016/j.jacc.2016.11.067
复制
发表时间：
2017-02-28
影响因子：
24
通讯作者：
IMAC-2 Investigators
中科院分区：
文献类型：
--
作者：
Nagatomo Y;McNamara DM;Alexis JD;Cooper LT;Dec GW;Pauly DF;Sheppard R;Starling RC;Tang WH;IMAC-2 Investigators
在各种心脏自身抗体（AAb）中，识别β1肾上腺素能受体（β 1 AR）的抗体表现出激动剂样作用，并诱导心肌损伤，这种损伤可被β受体阻滞剂和免疫球蛋白G3（IgG 3）免疫吸附逆转。我们研究了属于IgG 3亚类的β1AR-AAbs在新发心肌病患者中的作用。在入组时抽取近期发生心肌病（左心室射血分数[LVEF] ≤0.40; <6个月）的受试者的外周血。在基线和6个月时测定IgG和IgG 3-β1AR-AAb的存在，并评估超声心动图。受试者随访长达4年。在353例入组受试者中，62例（18%）IgG 3-β1AR-AAb（IgG 3）阳性，58例（16%）IgG阳性但非IgG 3（非IgG 3），其余均为阴性。基线时，各组之间的基线收缩压、心率或LVEF无显著差异。与其他组相比，非IgG 3组的LV舒张末期和收缩末期（分别为LVEDD和LVESD）直径显著更大（LVEDD：p < 0.01; LVESD：p = 0.03）。6个月时，IgG 3组的LVEF显著较高（p = 0.007）。多元回归分析表明，即使在多变量校正后，IgG 3-β1AR-AAb也是6个月时LVEF和6个月内LVEF变化的独立预测因子（6个月时LVEF，β = 0.20，p = 0.01; LVEF变化，β = 0.20，p = 0.008）。在基线时具有高纽约心脏协会心功能分级（III或IV）的受试者中，IgG 3组的全因死亡、心脏移植和因心力衰竭住院的复合终点发生率较低，而非IgG 3组的复合终点发生率最高。IgG 3-β1AR-AAb与近期发作心肌病患者的心肌恢复更有利相关。
Among various cardiac autoantibodies (AAb), 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. We investigated the role of β1AR-AAbs belonging to the IgG3 subclass in patients with recent-onset cardiomyopathy. Peripheral blood was drawn at enrollment in subjects with recent-onset cardiomyopathy (left ventricular ejection fraction [LVEF] ≤0.40; <6 months). Presence of IgG and IgG3-β1AR-AAb was determined and echocardiograms assessed at baseline and 6 months. Subjects were followed for up to 4 years. Among the 353 enrolled subjects, 62 (18%) were positive for IgG3-β1AR-AAb (IgG3), 58 (16%) were positive for IgG but not IgG3 (non-IgG3), and the remaining were negative. There were no significant differences in baseline systolic blood pressure, heart rate, or LVEF among the groups at baseline. LV end-diastolic and end-systolic (LVEDD and LVESD, respectively) diameters were significantly larger in the non-IgG3 group compared to the other groups (LVEDD: p < 0.01; LVESD: p = 0.03). At 6 months, LVEF was significantly higher in the IgG3 group (p = 0.007). Multiple regression analysis demonstrated 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 the subjects with high New York Heart Association functional class (III or IV) at baseline, the IgG3 group had 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. IgG3-β1AR-AAb was associated with more favorable myocardial recovery in patients with recent-onset cardiomyopathy.