The Number of Regulatory T Cells Correlates with Hemodynamic Improvement in Patients with Inflammatory Dilated Cardiomyopathy After Immunoadsorption Therapy

Inflammatory DCM ( iDCM ) may be related to autoimmune processes. An immunoadsorption ( IA ) has been reported to improve cardiac hemodynamics. The benefit of IA is probably related to the removal of autoantibodies. A recent study suggests additional effects of IA on the T cell–mediated immune reactions, especially on regulatory T cells ( T regs). In this prospective study, the correlation between the level of T regs and improvement of myocardial contractility in response to IA in patients with iDCM was investigated. Patients ( n  = 18) with iDCM , reduced left ventricular ( LV ) ejection fraction (<35%), were enrolled for IA . Before and 6 months after IA , LV systolic function was assessed by echocardiography, and blood levels of T regs were quantified by FACS analysis. Patients ( n  = 12) with chronic ischaemic heart failure and comparable reduced LV ‐ EF served as controls. IA improved LV ‐ EF in 12 of 18 patients at 6‐month follow‐up. These patients were classified as ‘ IA responder’. In 6 patients, LV ‐ EF remained unchanged. At baseline, IA responder and non‐responder subgroups showed similar values for C ‐reactive protein, white blood cells, lymphocytes and T helper cells, but they differ for the number of circulating Tregs (responder: 2.32 ± 1.38% versus non‐responder: 4.86 ± 0.28%; P  < 0.01). Tregs increased significantly in the IA responders, but remained unchanged in the IA non‐responders. In patients with ischaemic cardiomyopathy, none of these values changed over time. A low level of T regs in patients with chronic iDCM may characterize a subset of patients who do best respond to IA therapy.