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L-carnitine treatment for congestive heart failure--experimental and clinical study
A Kobayashi1, Y Masumura, N Yamazaki
1Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
Insights
L-carnitine supplementation may improve heart function by restoring energy production in patients with heart failure. Studies in hamsters and humans show reduced carnitine levels in heart disease, and L-carnitine treatment improved cardiac health and exercise capacity.
Area of Science:
- Cardiology
- Biochemistry
- Pharmacology
Background:
- Heart failure is associated with reduced myocardial carnitine levels.
- BIO 14.6 hamsters and patients with heart failure exhibit lower free carnitine and higher long-chain acylcarnitine levels.
- Carnitine deficiency impacts myocardial energy metabolism.
Purpose of the Study:
- To evaluate the therapeutic efficacy of L-carnitine in heart failure.
- To investigate the role of carnitine levels in myocardial function.
- To assess L-carnitine's impact on exercise tolerance and heart failure symptoms.
Main Methods:
- Studied cardiomyopathic BIO 14.6 hamsters and patients with chronic congestive heart failure and ischemic heart disease.
- Measured myocardial free and long-chain acylcarnitine levels.
- Administered L-carnitine intraperitoneally to hamsters and orally to patients, assessing outcomes like exercise tolerance and NYHA class.
Main Results:
- Reduced myocardial free carnitine levels were observed in both hamsters and heart failure patients.
- Long-chain acylcarnitine levels were significantly higher in heart failure patients.
- L-carnitine administration prevented myocardial damage in hamsters, improved exercise tolerance in patients with angina, and improved NYHA class and overall condition in heart failure patients.
Conclusions:
- L-carnitine deficiency is linked to heart failure.
- L-carnitine treatment demonstrates therapeutic efficacy in improving cardiac function and symptoms.
- L-carnitine may restore fatty acid oxidation, supporting its use as an adjunct therapy for congestive heart failure.
Abstract:
To evaluate the therapeutic efficacy of l-carnitine in heart failure, the myocardial carnitine levels and the therapeutic efficacy of l-carnitine were studied in cardiomyopathic BIO 14.6 hamsters and in patients with chronic congestive heart failure and ischemic heart disease. BIO 14.6 hamsters and patients with heart failure were found to have reduced myocardial free carnitine levels (BIO 14.6 vs FI, 287 +/- 26.0 vs 384.8 +/- 83.8 nmol/g wet weight, p less than 0.05; patients with heart failure vs without heart failure, 412 +/- 142 vs 769 +/- 267 nmol/g p less than 0.01). On the other hand, long-chain acylcarnitine level was significantly higher in the patients with heart failure (532 +/- 169 vs 317 +/- 72 nmol/g, p less than 0.01). Significant myocardial damage in BIO 14.6 hamsters was prevented by the intraperitoneal administration of l-carnitine in the early stage of cardiomyopathy. Similarly, oral administration of l-carnitine for 12 weeks significantly improved the exercise tolerance of patients with effort angina. In 9 patients with chronic congestive heart failure, 5 patients (55%) moved to a lower NYHA class and the overall condition was improved in 6 patients (66%) after treatment with l-carnitine. L-carnitine is capable of reversing the inhibition of adenine nucleotide translocase and thus can restore the fatty acid oxidation mechanism which constitutes the main energy source for the myocardium. Therefore, these results indicate that l-carnitine is a useful therapeutic agent for the treatment of congestive heart failure in combination with traditional pharmacological therapy.