Journal Mobile Options
Table of Contents
Vol. 116, No. 3, 2010
Issue release date: August 2010
Cardiology 2010;116:178–182

L-Carnitine Treatment in Patients with Mild Diastolic Heart Failure Is Associated with Improvement in Diastolic Function and Symptoms

Serati A.R. · Motamedi M.R. · Emami S. · Varedi P. · Movahed M.R.
aCardiovascular Research Center, Modarres Hospital, Tehran, bRadiology Department of Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; cSouthern Arizona VA Health Care System and University of Arizona Sarver Heart Center, Tucson, Ariz., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Objectives:L-Carnitine is a crucial component of activated fatty acid transport. The aim of this study was to evaluate the effect of L-carnitine on patients with a history of mild heart failure and diastolic dysfunction. Methods: Twenty-nine patients with a history of NYHA functional class II symptoms and ejection fraction >45% with documented grade 1 diastolic dysfunction on echocardiogram were randomized in blinded fashion to receive 1,500 mg of L-carnitine daily for 3 months in comparison to a no treatment group (31 patients). Baseline echocardiographic and follow-up measurements of diastolic parameters were assessed after 3 months. Results: Important parameters of diastolic function improved in the L-carnitine group only: left atrial size (3.6 ± 0.4 cm before treatment vs. 3.4 ± 0.5 cm after treatment, p = 0.01); isovolemic relaxation time (127 ± 26 ms before vs. 113 ± 24 ms after treatment, p = 0.007); septal mitral E′ velocity (0.064 ± 0.01 m/s before vs. 0.074 ± 0.01 m/s after treatment, p = 0.01), and lateral mitral E velocity (0.082 ± 0.01 m/s before vs. 0.091 ± 0.02 m/s after treatment, p = 0.006). Dyspnea also significantly improved in L-carnitine-treated patients. Conclusion: In patients with a history of diastolic heart failure, important indices of diastolic function and symptoms appear to improve with L-carnitine treatment.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ: Burden of systolic and diastolic ventricular dysfunction in the community: Appreciating the scope of the heart failure epidemic. JAMA 2003;289:194–202.
  2. Pedersen F, Raymond I, Madsen LH, Mehlsen J, Atar D, Hildebrandt P: Echocardiographic indices of left ventricular diastolic dysfunction in 647 individuals with preserved left ventricular systolic function. Eur J Heart Fail 2004;6:439–447.
  3. Razeghi P, Young ME, Alcorn JL, Moravec CS, Frazier OH, Taegtmeyer H: Metabolic gene expression in fetal and failing human heart. Circulation 2001;104:2923–2931.
  4. Anand I, Chandrashekhan Y, De Giuli F, Pasini E, Mazzoletti A, Confortini R, Ferrari R: Acute and chronic effects of propionyl-L-carnitine on the hemodynamics, exercise capacity and hormones in patients with congestive heart failure. Cardiovasc Drugs Ther 1998;12:291–299.
  5. Investigators of the Study on Propionyl-L-carnitine in Chronic Heart Failure: Study on propionyl-L-carnitine in chronic heart failure. Eur Heart J 1999;20:70–76.
  6. Pastoris O, Dossena M, Foppa P, Catapano M, Arbustini E, Bellini O, Dal Bello B, Minzioni G, Ceriana P, Barzaghi N: Effect of L-carnitine on myocardial metabolism: results of a balanced, placebo-controlled, double-blind study in patients undergoing open heart surgery. Pharmacol Res 1998;37:115–122.
  7. Bartels GL, Remme WJ, Holwerda KJ, Kruijssen DA: Anti-ischaemic efficacy of L-propionylcarnitine – a promising novel metabolic approach to ischaemia? Eur Heart J 1996;17:414–420.
  8. Bartels GL, Remme WJ, den Hartog FR, Wielenga RP, Kruijssen DA: Additional anti-ischemic effects of long-term L-propionylcarnitine in anginal patients treated with conventional antianginal therapy. Cardiovasc Drugs Ther 1995;9:749–753.
  9. Bartels GL, Remme WJ, Pillay M, Schönfeld DH, Kruijssen DA: Effects of L-propionylcarnitine on ischemia-induced myocardial dysfunction in men with angina pectoris. Am J Cardiol 1994;74:125–130.
  10. Singh RB, Niaz MA, Agarwal P, Beegum R, Rastogi SS, Sachan DS: A randomized, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction. Postgrad Med J 1996;72:45–50.
  11. Iliceto S, Scrutinio D, Bruzzi P, D’Ambrosio G, Boni L, Di Biase M, Biasco G, Hugenholtz PG, Rizzon P: Effects of L-carnitine administration on left ventricular remodelling after acute anterior myocardial infarction: the L-carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial. J Am Coll Cardiol 1995;26:380–387.
  12. Gasparetto A, Corbucci GG, De Blasi RA, Antonelli M, Bagiella E, D’Iddio S, Trevisani C: Influence of acetyl-L-carnitine infusion on hemodynamic parameters and survival of circulatory-shock patients. Int J Clin Pharmacol Res 1991;11:83–92.
  13. Corsi C, Pollastri M, Marrapodi E, Leanza D, Giordano S, D’Iddio S: L-Propionylcarnitine effect on postexercise and postischemic hyperemia in patients affected by peripheral vascular disease. Angiology 1995;46:705–713.
  14. Abhayaratna WP, Marwick TH, Smith WT, Becker NG: Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey. Heart 2006;92:1259–1264.
  15. Engel AG, Angelini C: L-Carnitine deficiency of human skeletal muscle with associated lipid storage myopathy: a new syndrome. Science 1973;179:899–902.
  16. Shug AL, Thomsen JH, Folts JD, Bittar N, Klein MI, Koke JR, Huth PJ: Changes in tissue levels of L-carnitine and other metabolites during myocardial ischemia and anoxia. Arch Biochem Biophys 1978;187:25–33.
  17. Paulson DJ: L-Carnitine deficiency-induced cardiomyopathy. Mol Cell Biochem 1998;180:33–41.
  18. Zaugg CE, Spaniol M, Kaufmann P, Bellahcene M, Barbosa V, Tolnay M, Buser PT, Krähenbühl S: Myocardial function and energy metabolism in L-carnitine-deficient rats. Cell Mol Life Sci 2003;60:767–775.
  19. Silverman NA, Schmitt G, Vishwanath M, Feinberg H, Levitsky S: Effect of L-carnitine on myocardial function and metabolism following global ischemia.Ann Thorac Surg 1985;40:20–24.
  20. Motterlini R, Samaja M, Tarantola M, Micheletti R, Bianchi G: Functional and metabolic effects of propionyl-L-carnitine in the isolated perfused hypertrophied rat heart. Mol Cell Biochem 1992;116:139–145.
  21. Rodriguez B, Xiang H, McNeil T: Effect of L-carnitine treatment on lipid metabolism and cardiac performance in chronically diabetic rats. Diabetes 1988;37:1358–1364.
  22. Bain MA, Milne RW, Evans AM: Disposition and metabolite kinetics of oral L-carnitine in humans. J Clin Pharmacol 2006;46:1163–1170.
  23. Kerner J, Hoppel C: Fatty acid import into mitochondria. Biochim Biophys Acta 2000;1486:1–17.
  24. Rosano GM, Vitale C, Sposato B, Mercuro G, Fini M: Trimetazidine improves left ventricular function in diabetic patients with coronary artery disease: a double-blind placebo-controlled study. Cardiovasc Diabetol 2003;2:16.
  25. Andreozzi GM: Propionyl L-carnitine: intermittent claudication and peripheral arterial disease. Expert Opin Pharmacother 2009; 10:2697–2707.
  26. Soukoulis V, Dihu JB, Sole M, Anker SD, Cleland J, Fonarow GC, Metra M, Pasini E, Strzelczyk T, Taegtmeyer H, Gheorghiade M: Micronutrient deficiencies an unmet need in heart failure. J Am Coll Cardiol 2009;54:1660–1673.
  27. Investigators of the Study on Propionyl-L-Carnitine in Chronic Heart Failure: Study on propionyl-L-carnitine in chronic heart failure. Eur Heart J 1999;20:70–76.
  28. Anand I, Chandrashekhan Y, De Giuli F, et al: Acute and chronic effects of propionyl-L-carnitine on the hemodynamics, exercise capacity, and hormones in patients with congestive heart failure. Cardiovasc Drugs Ther 1998;22:291–299.

    External Resources

  29. Löster H, Miehe K, Punzel M, Stiller O, Pankau H, Schauer J: Prolonged oral L-carnitine substitution increases bicycle ergometer performance in patients with severe, ischemically induced cardiac insufficiency. Cardiovasc Drugs Ther 1999;13:537–546.
  30. Rizos I: Three-year survival of patients with heart failure caused by dilated cardiomyopathy and L-carnitine administration. Am Heart J 2000;139:S120–S123.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50