Author’s response to: letter to the editor

Excerpt

Thank you very much for the comment to our review article “The heart failure burden of type 2 diabetes mellitus—a review of pathophysiology and interventions.” For patients with a treatment refractory heart failure, or difficult-to-treat heart failure, alternative etiologies should be sought. Herein, considerations of inflammation and autoimmunity are highly relevant. Addressing inflammation is relevant as there are suggestions of potential benefit of intravenous immunoglobulin therapy in patients with heart failure of different etiologies including dilated cardiomyopathy [1], and addressing autoimmunity is relevant since removal of cardiac autoantibodies could result in symptom relief. However, we would like to emphasize that although the method of immunoadsorption is well characterized for certain autoantibodies, the identification and characterization of the key contributing autoantibody/ies that promote cardiac damage leading to heart failure, and thus the identification of patients that are likely to benefit from treatment, is not yet established, nor is this method broadly established in clinical practice [2]. Immunoadsorption is therefore not recommended by the European Society of Cardiology’s, or the American Heart Association and American College of Cardiology’s guidelines [3‐5], although recommended by the American Society of Apheresis as mentioned by the authors. …