Abstract
We investigated whether chronic intravenous administration of l-carnitine could improve myocardial fatty acid imaging in patients on maintenance hemodialysis. We enrolled 72 hemodialysis patients who had impaired myocardial fatty acid imaging and left ventricular dysfunction not based on coronary lesion. l-Carnitine (1,000 mg) was intravenously administered after dialysis for 1 year to 36 participants (Carnitine group), while not in the other 36 participants (Control group). Single-photon emission computed tomography (SPECT) using an iodinated fatty acid analogue, BMIPP, was performed. Uptake on SPECT images was graded in 17 segments on a five-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores. During follow-up, 19 participants were discontinued from the study, and 53 participants (65 ± 12 years: 27 carnitine, 26 control) were analyzed. The mean BMIPP summed scores 1 year after carnitine administration did not differ from that before in the carnitine group, nor from that in the control group. However, improved SPECT (Changes in BMIPP summed scores <−20%) was found in 7 (25.9%) participants in the carnitine, whereas in 2 (7.7%) in the control group. Multivariate logistic analysis showed the improved SPECT was inversely associated with baseline serum albumin levels (1 g/L: odds ratio, 0.669); the cut-off was 35 g/L. Chronic intravenous l-carnitine might improve myocardial fatty acid imaging in a selected group of hemodialysis patients with hypoalbuminemia.
Highlights
Carnitine plays an important role in myocardial fatty acid metabolism by transporting long-chain free fatty acids (FFA) from the cytoplasm to the matrix of myocardial and skeletal muscle mitochondria for β-oxidation
Eligibility criteria of this study were as follows: (1) Patients on chronic hemodialysis with a history of heart failure needing hospitalization except fluid overload from June 1st, 2012 to May 31st, 2013; (2) No significant obstructive coronary artery disease (CAD) identified by angiography within one year of the study; (3) LV dysfunction evaluated by echocardiography: mildly or moderately reduced LV systolic function [left ventricular ejection fraction (LVEF)
The present study showed that chronic intravenous administration of l-carnitine did not significantly affect mean BMIPP SS evaluated by Single-photon emission computed tomography (SPECT) in hemodialysis patients with LV dysfunction, circulating levels of l-carnitine increased almost six-fold at 3 month of administration
Summary
Carnitine plays an important role in myocardial fatty acid metabolism by transporting long-chain free fatty acids (FFA) from the cytoplasm to the matrix of myocardial and skeletal muscle mitochondria for β-oxidation. Sakurabayashi et al reported that chronic oral administration of l-carnitine to hemodialysis patients did not change myocardial accumulation of 123I-β-methyliodophenyl pentadecanoic acid (BMIPP), an iodinated analogue of free FFA, or LV dimension or function, but it increased the washout rate of 123I-BMIPP (Sakurabayashi et al 1999). No study has been reported regarding the effect of l-carnitine on singlephoton emission computed tomography (SPECT) using 123I-BMIPP, of which improvement may contribute to betterment of LV dysfunction or decrease in cardiac death (Nishimura et al 2006, 2008a, b, 2011, 2014, 2015; Moroi et al 2013). Nishimura et al SpringerPlus (2015) 4:353 whether chronic intravenous administration of l-carnitine could improve impaired myocardial fatty acid imaging in patients on maintenance hemodialysis with LV dysfunction not based on obstructive coronary artery disease (CAD) or valvular heart diseases
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