The mean disease duration of iDCM was 14 months, and mean treatment duration, 5 months (range 4–7 months). The diagnosis of iDCM based on previous myocardial biopsies demonstrating immunohistochemical evidence of cardiac inflammation

(presence of >14 lymphocytes (CD3+) or macrophages (CD68+)/mm2, diffuse, focal or confluent, enhanced HLA class II expression in antigen-presenting Small molecule library molecular weight immune cells) according to the World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies [20], and the absence of cardiotropic viruses (test for human herpesvirus-6, parvovirus B19, Epstein-Barr virus, cytomegalovirus, HIV, ECHO, Coxsackie A/B, Influenza, adenovirus) in cardiac biopsies (as judged by polymerase chain reaction/in situ hybridization). Twelve age-matched patients with chronic ischaemic heart failure and five patients with iDCM who refused IA therapy and with comparable

reduced ejection fraction served as controls. Exclusion criteria were clinical or biochemical evidence for the presence of a systemic inflammatory disease, renal insufficiency (serum creatinine >1.8 mg/dl), Belnacasan manufacturer malignant diseases, thrombocytopenia (<100,000/μl) or anaemia (haemoglobin <11.0 g/dl). Blood samples were drawn before an IA course of 5 days and 6 months after IA. Before IA treatment and during follow-up visit, clinical examination, routine blood investigations, ECG and transthoracic echocardiography Fossariinae were performed. The echocardiograms Philips iE33 (Philips, Amsterdam, the Netherlands) were performed by cardiologists not related to this study,

and unaware of the blood testing results. LV ejection fraction (EF) was derived using Simpson’s modified biplane method; left ventricular enddiastolic diameter (LVEDD) was assessed in parasternal longitudinal axis (M-Mode). After insertion of a high-flow catheter into the right jugular vein, 2.5-fold plasma volumes were treated for five consecutive days using protein A agarose columns (Immunosorba; Fresenius Medical Care AG, Bad Homburg, Germany) with acid citrate dextrose solution A (ACD-A) anticoagulation [21]. Plasma was separated for treatment per centrifugation (ComTec; Fresenius Medical Care, Bad Homburg, Germany); protein A agarose columns were inserted in ADAsorb (Medicap, Ulrichstein, Germany) filtration device. Weight was maintained at a stable level, and furosemide i.v. was applied as necessary. Furthermore calcium carbonate was supplemented orally if patients suffered from paraesthesia or other signs of hypocalcemia. After immunoadsorption, polyclonal immunoglobulin (Intratect®; Biotest AG, Dreieich, Germany) was substituted at 0.5 g per kilogram body weight. In our control patients, (1. with chronic ischaemic heart failure, 2. iDCM who refused IA) blood samples were collected under similar conditions as performed for the patients with iDCM (at baseline and after a 6-month interval).