Myocardial Energy Metabolism Has Major Role Or Supporting Role In Treatment Of Heart Failure?

Objectives:Chronic heart failure is the end stage of cardiovascular disease progression and majorcause of death. At present, result of intervention through neuro-endocrine mechanism is stillnot very ideal. This year researches showed myocardial energy metabolism disorder is one ofthe major mechanisms of heart failure progression. By decreasing excess myocardial energyconsumption and improving myocardial energy metabolism, prognosis of heart failure can beimproved. L-carnitine is the natural substance inside the body, which is important inmammalian energy metabolism. Its major function is to promote lipid metabolism. It hasimportant role in cellular energy metabolism. Large chain fatty acids undergo β oxidationwhich depends on L-carnitine for transport. This research is used levocarnitine, which isadded to standard therapy for the treatment of chronic heart failure (CHF), and investigate itseffectiveness and dose correlation for CHF treatment.Methods:120cases with CHF were selected from in patients of our department from February,2012to June,2013. All patients with cardiac disease met CHF diagnostic criteria. Amongthem56males,64females, age between43to78years, mean (58±12) years. The120enrolled patients were randomly divided into three groups: control group, treatment1groupand treatment2group with40patients in each group. Control group received generalstandardized heart failure drug therapy, such as digitalis, diuretics,rennin-angiotensin-aldosterone inhibitors, β blockers etc. If any infection, they weregiven antibiotics. Enough rest and low salt low lipid diet were recommended duringtreatment. Treatment1group received levocarnitine2.0g with0.9%normal saline20ml intravenous bolus bid in addition to standardized drug therapy and used for7dayscontinuously (leveocarnitine injection was from Italy Sigma-Tau pharmaceuticals,trade name carnitene, import registration number H20080513). Treatment2groupreceiving levocarnitine4.0g with0.9%normal saline20ml intravenous bolus bid inaddition to standardized drug therapy and used for7days continuously (leveocarnitineinjection was from Italy Sigma-Tau pharmaceuticals, trade name carnitene, importregistration number H20080513). All patients of three groups were evaluated by cardiac function (NYHA grading), plasma BNP and left ventricular ejection fraction(LVEF), simultaneously results were compared. The patients selected for this researchhad already documented cardiac disease, symptoms meeting with NYHA cardiacfunction grading and left ventricular ejection fraction (LVEF)≤50%, which was donein echocardiography department of our hospital after admission. The patients with corpulmonale, pulmonary hypertension, pericarditis, co-morbities with severe disease ormajor organ diseases such as severe hepatic, renal insufficiency, immune systemdiseases, anemia, hemorrhage, severe infection (septicemia, lung infections), andmalignant tumor were excluded. All data were analyzed statistically by using SPSS12.0package. Results were expressed as（±s）. The comparison between before andafter therapy in a group used paired sample t test, and comparison between groups usedt test, and P<0.05was considered as statistically significance.Results:1.Comparison of Plasma B-type natriuretic peptide (BNP) pg/ml test results1.1L-carnitine2.0group has significant BNP level decreased after treatment whencompared with before treatment, and the difference had statistical significance(1927.0±1176.0pg/mlvs1022.3±833.7pg/ml, P <0.05).L-carnitine4.0group hassignificant BNP level decreased after treatment when compared with before treatment,and the difference had statistical significance (2046.2±1213.3pg/mlvs1022.3±833.7pg/ml, P <0.05).It indicates using levocarnitine, plasma BNP level can bedecreased significantly..1.2After7d treatment, plasma BNP results between L-carnitine2.0group and controlgroup has statistical significance (1022.3±833.7pg/mlvs1375.9±1124.1pg/ml, P <0.05).after7d treatment, plasma BNP results between L-carnitine4.0group andcontrol group also has statistical significance (958.7±531.1pg/ml vs1375.9±1124.1pg/ml, P <0.05). It indicates plasma BNP level is lower in the group who usedlevocarnitine than the control group.1.3After7d treatment, the plasma BNP level between L-carnitine2.0group and L-carnitine4.0group has statistical significance (1022.3±833.7pg/mlvs958.7±531.1pg/ml,P <0.050.05). It indicates, plasma BNP level is lower in levocarnitine4.0group thenlevocarnitine2.0group.2. Comparison of Left ventricular ejection fraction (LVEF)%test results2.1L-carnitine2.0group has significant LVEF increased after treatment when compared with before treatment, and the difference had statistical significance(41±7%vs46±6%, P <0.05). L-carnitine4.0group has significant LVEF increased aftertreatment when compared with before treatment, and the difference had statisticalsignificance (38±9%vs47±8%, P <0.05). It indicates LVEF significantly increases afterL-carnitine therapy.2.2After7d treatment, LVEF results between L-carnitine2.0group and control grouphas statistical significance (46±6%vs38±9%, P <0.05). after7d treatment, LVEF resultsbetween L-carnitine4.0group and control group also has statistical significance(47±8%vs38±9%, P <0.05).It indicates LVEF is higher in the group who used L-carnitine than the control group.2.3After7d treatment, the LVEF between L-carnitine2.0group and L-carnitine4.0hasstatistical significance (46±6%vs47±8%, P <0.050.05). It indicates, LVEF is higher inL-carnitine4.0group then L-carnitine2.0group.Conclusions:Addition of L-carnitine on standardized therapy can1. A significant reduction in plasma b-type natriuretic peptide levels.2. To reduce the level of plasma BNP and l-carnitine dose were positively correlated.3. Improve left ventricular ejection fraction (LVEF)%.4. Increase the degree of LVEF and l-carnitine dose were positively correlated.5. L-carnitine in heart failure treatment compared with the conventional treatment groupcurative effect is distinct, which fully embodies the energy metabolism of drugs in adominant position in the treatment of heart failure, we can say for sure energymetabolism drugs is the leading role is not a supporting role.