Iliceto S, Scrutinio D, Bruzzi P, D'Ambrosio G, Boni L, Di Biase M, Biasco G, Hugenholtz P G, Rizzon P
Institute of Cardiology, University of Bari, Italy.
J Am Coll Cardiol. 1995 Aug;26(2):380-7. doi: 10.1016/0735-1097(95)80010-e.
This study was performed to evaluate the effects of L-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infarction.
Carnitine is a physiologic compound that performs an essential role in myocardial energy production at the mitochondrial level. Myocardial carnitine deprivation occurs during ischemia, acute myocardial infarction and cardiac failure. Experimental studies have suggested that exogenous carnitine administration during these events has a beneficial effect on function.
The L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial was a randomized, double-blind, placebo-controlled, multicenter trial in which 472 patients with a first acute myocardial infarction and high quality two-dimensional echocardiograms received either placebo (239 patients) or L-carnitine (233 patients) within 24 h of onset of chest pain. Placebo or L-carnitine was given at a dose of 9 g/day intravenously for the first 5 days and then 6 g/day orally for the next 12 months. Left ventricular volumes and ejection fraction were evaluated on admission, at discharge from hospital and at 3, 6 and 12 months after acute myocardial infarction.
A significant attenuation of left ventricular dilation in the first year after acute myocardial infarction was observed in patients treated with L-carnitine compared with those receiving placebo. The percent increase in both end-diastolic and end-systolic volumes from admission to 3-, 6- and 12-month evaluation was significantly reduced in the L-carnitine group. No significant differences were observed in left ventricular ejection fraction changes over time in the two groups. Although not designed to demonstrate differences in clinical end points, the combined incidence of death and congestive heart failure after discharge was 14 (6%) in the L-carnitine treatment group versus 23 (9.6%) in the placebo group (p = NS). Incidence of ischemic events during follow-up was similar in the two groups of patients.
L-Carnitine treatment initiated early after acute myocardial infarction and continued for 12 months can attenuate left ventricular dilation during the first year after an acute myocardial infarction, resulting in smaller left ventricular volumes at 3, 6 and 12 months after the emergent event.
本研究旨在评估左旋肉碱对急性前壁心肌梗死患者长期左心室扩张的影响。
肉碱是一种生理化合物，在线粒体水平的心肌能量产生中发挥重要作用。在缺血、急性心肌梗死和心力衰竭期间会发生心肌肉碱缺乏。实验研究表明，在这些情况下给予外源性肉碱对心脏功能有有益影响。
左旋肉碱数字化超声心动图心肌梗死（CEDIM）试验是一项随机、双盲、安慰剂对照、多中心试验，472例首次急性心肌梗死且有高质量二维超声心动图的患者在胸痛发作后24小时内接受安慰剂（239例患者）或左旋肉碱（233例患者）治疗。安慰剂或左旋肉碱在前5天以9克/天的剂量静脉给药，然后在接下来的12个月以6克/天的剂量口服。在入院时、出院时以及急性心肌梗死后3、6和12个月评估左心室容积和射血分数。
与接受安慰剂的患者相比，接受左旋肉碱治疗的患者在急性心肌梗死后第一年左心室扩张明显减轻。左旋肉碱组从入院到3个月、6个月和12个月评估时舒张末期和收缩末期容积的增加百分比均显著降低。两组左心室射血分数随时间的变化没有显著差异。虽然该试验并非旨在证明临床终点的差异，但左旋肉碱治疗组出院后死亡和充血性心力衰竭的合并发生率为14例（6%），而安慰剂组为23例（9.6%）（p=无显著性差异）。两组患者随访期间缺血事件的发生率相似。
急性心肌梗死后早期开始并持续12个月的左旋肉碱治疗可减轻急性心肌梗死后第一年的左心室扩张，使急诊事件后3个月、6个月和12个月时左心室容积更小。
