Inflammation and chronic heart failure-potential therapeutic role of intravenous immunoglobulin.

Accumulating evidence indicates that inflammatory cytokines play a pathogenic role in congestive heart failure (CHF) by influencing heart contractility, inducing hypertrophy and promoting apoptosis or fibrosis, contributing to the continuous myocardial remodelling process. Traditional cardiovascular drugs seem to have little influence on the overall cytokine network, and immunomodulatory therapy have emerged as a possible new treatment modality in CHF. Several animal studies have suggested that modulation of inflammatory cytokines may improve cardiac performance, and we have recently demonstrated that intravenous immunoglobulin enhances left ventricular ejection fraction in CHF patients, significantly correlated with anti-inflammatory effects of such therapy. While not necessarily the drugs of choice, these studies suggest a potential for immunomodulatory therapy in CHF in addition to optimal cardiovascular treatment regimens. Further research will have to more precisely identify the most important actors in the immunopathogenesis of CHF in order to develop more specific immunomodulating agents in this disorder. Although these shortcomings, we believe that the 'cytokine era' in cardiovascular research might lead to quite new treatment modalities in CHF patients potentially leading to reduced morbidity and mortality in these patients.