Effects of L-carnitine on Serum Lactate and Cardiac Complications in Patients With Heart Failure Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Document Type: Original Article

Authors

1 Department of Anesthesiology, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

2 Department of Anesthesiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

3 Department of Anesthesiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

4 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

5 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: The effects of L-carnitine on serum lactate and its metabolism remain uncertain, particularly in candidates for revascularization with a high likelihood of a postoperative rise in lactate levels. The present study aimed to assess the effects of L-carnitine on lactate levels after coronary artery bypass graft surgery (CABG) in patients with grade I heart failure.
 
Methods: in this randomized clinical trial, 64 consecutive patients suffering from mild heart failure (grade I) who were candidated for coronary revascularization were randomly divided into 2 groups (32 patients in each group) receiving L-carnitine (3 g orally 2 hours before surgery) or a placebo for the same duration before surgery.  Postoperative adverse events, as well as the trend of the change in the levels of serum lactate, creatinine, and hemoglobin, within 24 hours after surgery were assessed.
 
Results: No difference was revealed between the 2 groups in terms of serum lactate levels before surgery (1.51 ± 0.79 in the intervention group vs 1.35 ± 0.43 in the control group; p = 0.33), during intra-aortic balloon pumping (2.27 ± 1.28 in the intervention group vs 2.70 ± 1.42 in the control group; p = 0.20), and also after separating the pump (2.96 ± 1.61 in the intervention group vs 2.56 ± 0.87 in the control group; p = 0.22). No difference was also observed concerning postoperative complications, including atrial fibrillation (p = 0.42), delirium (p = 0.99), agitation (p = 0.88), intra-aortic balloon pump insertion (p = 0.99), atelectasis (p = 0.98), and respiratory distress (p = 0.99).
 
Conclusions: Administrating L-carnitine had no protective effects on the rise in postoperative serum lactate levels following CABG in our patients with low-grade heart failure. (Iranian Heart Journal 2020; 21(4): 14-24)
 
 

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  1. World Health Organization, The top 10 causes of death, 24 May 2018, available in: [https://www.who.int/].
  2. Inamdar AA1, 2, Inamdar AC3. Heart Failure: Diagnosis, Management and Utilization. J Clin Med. 2016 Jun 29;5(7). pii: E62. doi: 10.3390/jcm5070062.
  3. Choi HM, Park MS, Youn JC. Update on heart failure management and future directions. Korean J Intern Med. 2019 Jan; 34(1):11-43.
  4. Khatibzadeh S, Farzadfar F, Oliver J, Ezzati M, Moran A. Worldwide risk factors for heart failure: a systematic review and pooled analysis. Int J Cardiol. 2013 Sep 30; 168(2):1186-94.
  5. Petrie MC, Jhund PS, She L, Adlbrecht C, Doenst T, Panza JA, Hill JA, Lee KL2, Rouleau JL7, Prior DL8, Ali IS9, Maddury J10, Golba KS11, White HD12, Carson P13, Chrzanowski L14, Romanov A15, Miller AB16, Velazquez EJ2; STICH Trial Investigators. Ten Year Outcomes After Coronary Artery Bypass Grafting According to Agein Patients With Heart Failure and Left Ventricular SystolicDysfunction: An Analysis of the Extended Follow-Up of the STICHTrial (Surgical Treatment for Ischemic Heart Failure). Circulation. 2016 Nov 1; 134(18):1314-1324. doi: 10.1161/CIRCULATIONAHA.116.024800. Epub 2016 Aug 29.
  6. Adamo L1, Nassif ME1, Novak E1, LaRue SJ1, Mann DL1. Prevalence of lactic acidaemia in patients with advanced heart failure and depressed cardiac output. Eur J Heart Fail. 2017 Aug; 19(8):1027-1033. doi: 10.1002/ejhf.628. Epub 2016 Sep 20.
  7. Biegus J, Zymliński R, Sokolski M, Gajewski P, Banasiak W, Ponikowski P. Clinical, respiratory, haemodynamic, and metabolic determinants of lactate in heart failure. Kardiol Pol. 2019;77(1):47-52
  8. Pekala J1, Patkowska-Sokoła B, Bodkowski R, Jamroz D, Nowakowski P, Lochyński S, Librowski T. L-carnitine--metabolic functions and meaning in humans life. Curr Drug Metab. 2011 Sep; 12(7):667-78.
  9. Longo N1, Frigeni M2, Pasquali M3. Carnitine transport and fatty acid oxidation. Biochim Biophys Acta. 2016 Oct; 1863(10):2422-35. doi: 10.1016/j.bbamcr.2016.01.023. Epub 2016 Jan 29.
  10. Chen YC, Chien YH, Chen PW, Leung-Sang Tang N, Chiu PC, Hwu WL, Lee NC. Carnitine uptake defect (primary carnitine deficiency): risk in genotype-phenotype correlation. Hum Mutat. 2013 Apr; 34(4):655. doi: 10.1002/humu.22286.
  11. Tomlinson S, Atherton J, Prasad S. Primary Carnitine Deficiency: A Rare, Reversible Metabolic Cardiomyopathy. Case Rep Cardiol. 2018 Sep 13;2018:3232105.
  12. Mingorance C1, Rodríguez-Rodríguez R, Justo ML, Alvarez de Sotomayor M, Herrera MD. Critical update for the clinical use of L-carnitine analogs in cardiometabolic disorders. Vasc Health Risk Manag. 2011; 7:169-76. doi: 10.2147/VHRM.S14356. Epub 2011 Mar 28.
  13. Eroğlu H1, Senel O, Güzel NA. Effects of acute L-carnitine intake on metabolic and blood lactate levels of elite badminton players. Neuro Endocrinol Lett. 2008 Apr; 29(2):261-6.
  14. Barnett C1, Costill DL, Vukovich MD, Cole KJ, Goodpaster BH, Trappe SW, Fink WJ. Effect of L-carnitine supplementation on muscle and blood carnitine content and lactate accumulation during high-intensity sprint cycling. Int J Sport Nutr. 1994 Sep; 4(3):280-8.
  15. Claessens YE, Cariou A, Chiche JD, Dauriat G, Dhainaut JF. L-Carnitine as a treatment of life-threatening lactic acidosisinduced by nucleoside analogues. AIDS. 2000 Mar 10; 14(4):472-3.
  16. Gönen MS. The Effect of L-Carnitine Treatment on Lactic Acid Levels in Normal Subjects and Patients with IGT. Turkish Journal of Endocrinology and Metabolism, (2005) 1: 13-16. 
  17. Kashef M, Amin Saei M. Acute Effect of L-Carnitine Supplements on Lactate, Glucose, Saturated Oxygen and VO2 max Variations in Young Males. Int J Basic Sci Med. 2017;2(1):46-51.
  18. Najafi M1, Javidnia A, Ghorbani-Haghjo A, Mohammadi S, Garjani A. Pharmacological preconditioning with L-carnitine: relevance to myocardial hemodynamic function and glycogen and lactate content. Pak J Pharm Sci. 2010 Jul; 23(3):250-5.
  19. Eroğlu H1, Senel O, Güzel NA. Effects of acute L-carnitine intake on metabolic and blood lactate levels of elite badminton players. Neuro Endocrinol Lett. 2008 Apr; 29(2):261-6.
  20. Barnett C1, Costill DL, Vukovich MD, Cole KJ, Goodpaster BH, Trappe SW, Fink WJ. Effect of L-carnitine supplementation on muscle and blood carnitine content and lactate accumulation during high-intensity sprint cycling. Int J Sport Nutr. 1994 Sep; 4(3):280-8.
  21. Dastan F1, Talasaz AH2, Mojtahedzadeh M3, Karimi A4, Salehiomran A4, Bina P4, Jalali A4 Randomized Trial of Carnitine for the Prevention of Perioperative Atrial Fibrillation. Semin Thorac Cardiovasc Surg. 2018 Spring; 30(1):7-13. doi: 10.1053/j.semtcvs.2017.08.006. Epub 2017 Aug 24.
  22. da Silva Guimarães S1, de Souza Cruz W, da Silva L, Maciel G, Huguenin AB, de Carvalho M, Costa B, da Silva G, da Costa C, D'Ippolito JA, Colafranceschi A, Scalco F, Boaventura G. Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery BypassGrafting: A Randomized, Placebo-Controlled Trial. Ann Nutr Metab. 2017; 70(2):106-110. doi: 10.1159/000465531. Epub 2017 Mar 25.
  23. Lynch KE1, Feldman HI, Berlin JA, Flory J, Rowan CG, Brunelli SM. Effects of L-carnitine on dialysis-related hypotension and muscle cramps: a meta-analysis. Am J Kidney Dis. 2008 Nov; 52(5):962-71. doi: 10.1053/j.ajkd.2008.05.031. Epub 2008 Aug 15.