New technologies, new therapies: toward personalized medicine in heart failure patients?

This editorial refers to ‘Myocardial gene expression profiles and cardiodepressant autoantibodies predict response of patients with dilated cardiomyopathy to immunoadsorption therapy’, by S. Ameling et al., doi:10.1093/eurheartj/ehs330 During the last decade, the therapeutic management of patients with left ventricular systolic dysfunction has improved. The major goals of the treatment are to reduce the mortality and the morbidity, to improve symptoms, and, if possible, to induce a reverse remodelling of the left ventricle.1 There is indeed a direct link between survival and left ventricular ejection fraction (LVEF). Drugs such as beta-blockers2,3 or, more recently, ivabradine,4 or interventions such as resynchronization therapy5 have been associated with a significant reverse remodelling in heart failure patients. However, the responses to these different treatments are highly variable. Some patients may undergo major reverse remodelling with a dramatic increase in LVEF (i.e. responders), while in others the LEVF remains unchanged (i.e. non-responders). Early identification of responders/non-responders may be associated with a better therapeutic management.In patients with dilated cardiomyopathy (DCM), a possible physio-pathological role for circulating autoantibodies against cardiac proteins has been suggested. Immunoadsorption (IA), by removing these …