Therapeutic Evaluation of L-Carnitine in Egyptian Children with Dilated Cardiomyopathy

Dilated Cardiomyopathy (DCM) represents a large subset of Congestive Heart Failure (CHF) cases. It is characterized by depressed systolic function, cardiomegaly and ventricular dilatation. Carnitine is indispensable for β-oxidation of long chain fatty acid in the mitochondria but also regulates the concentration and removal of the produced acyl groups. The aim of this study was to estimate the L-Carnitine levels in dilated cardiomyopathic patients on conventional treatment for heart failure both pre and post L-carnitine therapy and to study the effect of L-carnitine as an adjuvant therapy on clinical status, ECG and echocardiographic parameters. Fourteen patients were included in the study with dilated cardiomyopathy (7 males and 7 females) on conventional treatment for heart failure with mean age of 43.64±24.06 ms. Patients included in the study were subjected to full medical history, thorough clinical examination, plain chest X- ray PA view, electrocardiography and echocardiography. Serum carnitine level were measured to all patients at the beginning of the study and repeated three months after L-carnitine therapy. Results proved that mean serum carnitine level showed a significant increase after therapy (p<0.01). Clinically, there was significant increase in effort tolerance (p<0.01) and decrease of dyspnea (p<0.05). Ventricular systolic functions were improved as assessed by EF and FS (p<0.01), in addition to reduction of the LV dimensions (p>0.05). R wave of lead V6 was also significantly reduced (p<0.05). After therapy serum carnitine level correlated significantly with the FS, LVEF and body weight (p<0.05), no other significant correlation could be detected. The study conclude that adding L-carnitine to conventional therapy in dilated cardiomyopathic children with congestive heart failure improves cardiac systolic function, increase LVEF, FS and reduce ventricular size without any recorded health hazard.