AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/IJBR-2021/006
*Corresponding Author: Aamir J. A. Mosawi. Advisor Doctor,Baghdad Medical City and the National Center for Training and Development of Iraqi Ministry of Health, Iraq
Citation: Aamir J. A. Mosawi (2021) The uses of L-Carnitine in cardiology. International Journal of Biomed Research. 1(1).DOI: 10.31579/IJBR-2021/006
Copyright: © 2021, Aamir J. A. Mosawi, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 01 March 2021 | Accepted: 12 March 2021 | Published: 16 March 2021
Keywords: l-carnitine, cardiology, heart disease
L-carnitine is a non-protein amino acid synthesized from the essential amino acids lysine and methionine or obtained from dietary sources. Accumulating scientific research evidence suggests that L-carnitine has beneficial cardiovascular effects, and a potential in the management of a variety of cardiovascular disorders including congestive heart failure. The aim of this paper is to review the uses of L-Carnitine in cardiology.
Conclusion: Chronic heart diseases remain an important cause of morbidity and mortality in Iraq and many other countries in the world suggesting a need for advancing their medical therapy, possibly through emphasis on impairment in substrate metabolism and heart energy and substrate utilization which contribute to contractile dysfunction, and not expected to improve with traditional therapies. Fat is the most important energy source for heart muscle , and carnitine is vital for normal fatty acid beta-oxidation, and inadequate carnitine can cause cardiac dysfunction.
There is convincing evidence from experimental and clinical research that L-Carnitine has a beneficial effect when used in the treatment of a variety of heart diseases including congestive heart failure, myocardial infarction, and angina. The effect of L-Carnitine can be attributed to cardio-protective effects against ischemia and increasing the rate of fatty acid transport into mitochondria. It can improve exercise tolerance and oxygen consumption leading to symptomatic improvement and mortality reduction. As an anti-anginal agent, it can reduce ST segment depression and left ventricular end-diastolic pressure. L-Carnitine can also improve myocardial ischemia by relieving inhibition of mitochondrial adenine nucleotide translocase.
L-carnitine is a non-protein amino acid synthesized from the essential amino acids lysine and methionine or obtained from dietary sources. There are two main natural forms of L-carnitine, Acetyl-L-carnitine and propionyl-L-carnitine. Physiological roles of L-carnitine include [1-12]:
1-L-carnitine has an important role in fatty acid metabolism as it is an essential cofactor of carnitine palmitoyltransferanse 1 (CPT1), which allows fatty acid transport into mitochondria and the incorporation of long chain fatty acids into the β-oxidation cycle to obtain acetyl-CoA.
2-L-carnitine has an important role in glucose metabolism through as modulates the intra-mitochondrial acetyl-CoA/CoA ratio and the pyruvate dehydrogenase complex (PDH).
3-L-carnitine reduces the accumulation of the intermediate products of β-oxidation by increasing the efflux of acyl and acetyl groups (acyl-carnitines and acetyl-carnitine) out of cells into the plasma.
Failure of this physiologic role with the accumulation of β-oxidation intermediates may contribute to the development of insulin resistance in heart and skeletal muscle and of heart failure and ischemia.
Therefore, L-carnitine supplementation may have beneficial effects in the treatment of insulin resistance and cardiovascular diseases, by restoring tissue carnitine of skeletal muscle and myocardium.
4-L-carnitine helps cardiomyocytes in meeting their absolute need for ATP, and thus preserving the pulsatile cardiac function, and help in maintaining cell and tissue viability.
As early as 1960s, experimental evidence from animal study on guinea pigs suggested abnormal metabolism of long chain fatty acids in heart failure associated with chronic constriction of the ascending aorta. Theses abnormalities were attributed to reduction in the level of myocardial carnitine which controls the oxidation rate of long chain fatty acids, a decrease in palmitic acid oxidation, and increased rate of palmitate incorporation into triglycerides and lecithin. Wittels and Spann (1968) exogenous carnitine can restore defective palmitate metabolism [1].
Morand et al (1979) reported the occurrence of lipidic myopathy diagnosed by muscle biopsy and associated with severe cardiomyopathy caused by a generalized carnitine deficiency in a girl who presented initially with nausea, vomiting and intermittent hypoglycemia. At the age of five years, the girl developed generalized muscular weakness with severe amyotrophy, and cardiomegaly. Thereafter, she developed severe heart failure. Treatment with carnitine chlorhydrate and a diet low in lipids and high in medium chain triglycerides was associated with rapid improvement in myopathy and heart failure [2].
Early during the 1980s, the occurrence of myocardial carnitine deficiency in chronic heart failure has been emphasized, and the possibility of using carnitine in heart failure has been suggested. A role in the prevention of arrhythmias in acute myocardial infarct has also been suggested (Lanni et al, 1980; Suzuki et al, 1982) [3, 4, 5].
Experimental evidence from animal study on hamster, suggested that cardiomyopathy associated with congestive heart failure resulting from carnitine deficiency (York and colleagues, 1983) [6].
Ramos et al (1983) reported a protective effect of carnitine in patients with diphtheric myocarditis in a controlled study which included 132 diphtheric patients, 73 patients of them were treated with DL-carnitine, 100 mg/kg/day during 4 days after hospitalization. Treatment reduced the incidence of heart failure (P = 0.0475), of pacemaker implants (P = 0.0256), and of lethality indexes due to myocarditis (P = 0.013) [7].
Experimental evidence from animal study on turkeys with spontaneous cardiomyopathy and turkeys with furazolidone-induced cardiomyopathy associated with heart failure suggested that liver synthesis of carnitine increases in response to hypotension to promote beta-oxidation of fatty acids as a cardiac energy source (Pierpont et al, 1985) [8].
Ghidini et al (1985) reported a controlled study which included 38 patients (22 men, 16 women) with heart failure, secondary to ischemic and/or hypertensive heart disease. Their age raged from 65 to 82 years. Treatment included digitalis, diuretics, and antiarrhythmic agents). 21 patients received also oral L-carnitine 1-g doses twice daily for 45 days, while 17 received placebo. L-carnitine treatment resulted in a distinct improvement with reduced heart rate, edema and dyspnea, and increased diuresis and a marked reduction in daily digitalis requirement. L-carnitine treatment was also associated with a significant lowering of cholesterol and triglyceride levels, and was not associated with adverse effects in any patient [9].
A double-blind clinical study reported the treatment of 115 patients with septic, cardiac and traumatic shock, with bolus intravenous dose of acetyl-L-carnitine followed by infusion for 12 hours. Treatment was associated with improvement in blood oxygenation and significant reduction in heart rate and right atrial pressure in patients cardiogenic shock. In patients with septic shock, treatment increased systolic and mean arterial pressures (Gasparett et al, 1991) [10].
Kobayashi and colleagues (1992) treated patients with ischemic heart disease with oral L-carnitine for 12 weeks. Treatment was associated with significant improvement in exercise tolerance of patients with effort angina. Of 9 treated patients with chronic congestive heart failure, 5 patients (55%) moved to a lower NYHA class and the overall condition was improved in 6 patients (66%) [11].
Fernandez and Proto (1992) reported that treatment of patient with chronic myocardial ischemia with 2 g daily of L-carnitine during 1 year was associated with lowering of rate of anginal pains, reducing the requirement of nitrates, and also improvement of physical performance [12].
Bartels (1992) emphasized the importance of myocardial carnitine content in controlling myocardial oxidative metabolism and energy transfer. They used L-propionylcarnitine, a potent analogue of L-carnitine in attempt to improve heart function through a possible positive inotropic effect in 32 fasting normotensive patients with coronary artery disease. They treated sixteen patients with L-propionylcarnitine (15 mg/kg), while sixteen control patients received a vehicle mannitol/acetate, infused over five minutes.
In the control group, heart contractility was reduced by 5% with a significant 11% reduction in stroke volume. While patients treated L-propionylcarnitine didn’t experience change in isovolumetric contractility indices, but the peak ejection and filling rates improved by 16% at 45 minutes. In addition, the cardiac output in the treated patients increased by 8%. However, treatment had no effect systemic or coronary hemodynamics and myocardial oxygen consumption, but lactate uptake increased by 42%. [13]
Mancini et al (1992) reported a controlled study which included 60 patients (48 and 73 years) with mild to moderate (II and III NYHA class) congestive heart failure whom were treated with digitalis and diuretics for at least three months, but remained symptomatic. Thirty patients were additionally treated with oral mg of propionyl-L-carnitine, three times a day for 180 days. After one month, treatment was associated with significant increases in the maximum exercise and ventricular ejection fraction. Accordingly, Mancini et al thought that propionyl-L-carnitine has undoubted therapeutic benefit in patients with congestive heart failure, and it can be efficaciously added to the standard therapy [14].
Pucciarelli et al (1992) reported a controlled study which included 50 patients (48-69 years) with mild-moderate congestive heart failure and were treated with digitalis and diuretic. 25 patients were treated with oral propionyl-L-carnitine 2 g in two divided doses. Treatment increased maximum exercise time on the treadmill increased 11.1
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
