| Objective: To explore the protection of L-carnitine for the ischemiccardiac muscle through observing the endurance of activities, the level of BNP,the incidence of malignant arrhythmia, left ventricular ejection fraction (LVEF)and major adverse cardiac events (MACE) in patients with ischemic heartfailure, which provided the basis for more effective and rational therapy.Methods: From February2010and October2011, patients with ischemiccardiomyopathy leading to chronic severe left heart failure were enrolled intothe study.159patients (87male,72female, the average age of69.31±9.82years old）with severe chronic heart failure (CHF, NYHA classification: Ⅲ~Ⅳ grade) were randomly divided into the L-carnitine group (80cases) and thecontrol group (79cases).The L-carnitine group were assigned to the dosage ofL-carnitine (Italy sigma-tau Corporation)5g per day intravenously for thefourteen days on the basis of conventional treatment, simultaneously, thecontrol group were assigned to conventional treatment. Cardiac function(NYHA classification), left ventricular ejection fraction (LVEF), the level ofbrain natriuretic peptide (BNP) were respectively evaluated before treatmeninto two groups. Then after treatment,6minutes’ walking test (6MWT),cardiac function, LVEF, the level of BNP,24hours dynamicelectrocardiogram (Holter), ERNA were respectively evaluated in two groups.All the patients mainly diagnosed ischemic cardiomyopathy (ischemic heartfailure) were in hospital. Exclusion standards were as follows:○1the originalsevere valvular heart disease, the severe heart failure, the originalcardiomyopathy;○2Acute myocardial infarction, prinzmetal’s variant angina;○3primary pulmonary hypertension, pulmonary heart disease;○4otherendocrine diseases or liver and renal dysfunction, malignancy immune systemdisease, anemia, bleeding, serious infection. 159patients were divided into the L-carnitine gruoup (80cases) and thecontrol group (79cases) according to the condition of treatment, all thepatients were admitted to the conventional treatment in hospital (includingantiplatelet, anticoagulation, cholesterol-lowering drugs called statins, nitrates,diuretics ACEI drugs or ARB drugs, β-receptor blocker, digoxin, aldosteroneinhibitors, etc.). The L-carnitine group were assigned to the dosage ofL-carnitine5g per day intravenously for the fourteen days on the basis ofconventional treatment, simultaneously, the control group were assigned toconventional treatment. The basic clinical date of all patients were collected indetail: gender, age, risk factors, myocardial enzymes, cardiac troponin I, renalfunction, electrolytes, blood lipids, blood glucose, BNP, echocardiography,heart function classification,6MWT, ultrasonic cardiogram, Holter and ERNA.All the data were analyzed with SPSS software (version13.0), continuousvariables were presented with mean±standard deviation, comparison betweenthe two groups with t test, categorical variables were presented with percentand compared between groups with the use of Chi-square tests or Fishersexact probability, Rank tests for the numerical variable data of the nonnormaldistribution and grade material. P-value of less than0.05was considered to bestatistically significant.Results:13cases in the L-carnitine group and3cases in the control group wereexcluded from the study. Actually, there were159patients was enrolled intothe study (87male and72female, the average age of54.54±12.03years old)and there were divided into the L-carnitine group (79cases) and the controlgroup (80cases).2Comparison of basic clinical information159patients with ischemic cardiomyopathy were enrolled into the study,of which79cases were in the control group (42male,37female, the averageage of68.61±11.15years old) and80cases were in the L-carnitine group (45male,35female, the average age of70.01±8.28years old. There were nosignificant difference between the L-carnitine group and the control group, such as risk factors: gender, age, smoking history, drinking histories, highblood pressure, diabetes, dyslipidemia, body mass index, etc. BNP, glycatedhemoglobin, platelet aggregation rate, ultrasonic cardiogram, cardiac functiongrading and oral drugs.3Comparison of the result of6-MWTAfter the use of drugs for14days, there were significant differences inthe result of6-MWT between the L-carnitine group and the control group(358.35±49.08m vs.332.45±50.00m，t=3.30，P=0.001), accounting for that6-MWT distance in the L-carnitine group was greater than the control group.4Comparison of the result of HolterAfter the use of drugs for14days, the result of Holter was that, comparedto the control group, the incidence of malignant arrhythmia was lower in theL-carnitine group, and there was significant difference between two groups(5.0％vs.15.2％，X2=4.56，P=0.033).5Comparison of the level of BNPAfter the use of drugs for14days, compared to the control group, thelevel of BNP was lower in the L-carnitine group, and there was significantdifference between two groups (423.11±104.32pg/ml vs.466.60±133.45pg/ml，P=0.023).6Comparison of the result of ERNAAfter the use of drugs for14days, the heart ejection fraction in theL-carnitine group was higher than that in the control group, but there was nosignificant difference between two groups (48.91%±6.21%vs.47.22%±5.29%，t=1.886，P=0.064).7Comparison of MACEThe MACE was8cases in the L-carnitine group during theirhospitalization, including cardiac deaths (0case), myocardial infarction (1case), severe heart failure (5cases), serious malignant arrhythmia (2cases).The MACE was10cases in the control group during their hospitalization,including cardiac deaths (0case), myocardial infarction (1case), severe heartfailure (6cases), serious malignant arrhythmia (3cases). Compared to the control group, there was no significant difference in MACE between twogroups (10.0%vs.12.66%, P=0.597). The incidence of myocardial infarction,serious heart failure, serious malignant arrhythmia, cardiogenic death washigher in the control group, but no significant difference was found betweentwo groups. No cardiac death happened in the two groups during theirhospitalization.Conclusion: L-carnitine for patients with ischemic heart failure on thebasis of conventional treatment can significantly improve the endurance ofactivities and reduce the incidence of malignant arrhythmia and the level ofBNP. |
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