EFFECTS OF L-CARNITINE ADMINISTRATION ON LEFT-VENTRICULAR REMODELING AFTER ACUTE ANTERIOR MYOCARDIAL-INFARCTION - THE E-ECOCARDIOGRAFIA-DIGITALIZZATA-INFARTO-MIOCARDICO (CEDIM) TRIAL

Objectives. This study was performed to evaluate the effects of L-carn itine administration on long-term left ventricular dilation in patient s with acute anterior myocardial infarction. Background. Carnitine is a physiologic compound that performs an essential role in myocardial e nergy production at the mitochondrial level. Myocardial carnitine depr ivation occurs during ischemia, acute myocardial infarction and cardia c failure. Experimental studies have suggested that exogenous carnitin e administration during these events has a beneficial effect on functi on. Methods. The L-Carnitine Ecocardiografia Digitalizzata Infarto Mio cardico (CEDIM) trial was a randomized, double-blind, placebo-controll ed, multicenter trial in which 472 patients with a first acute myocard ial infarction and high quality two-dimensional echocardiograms receiv ed 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 dos e of 9 g/day intravenously for the first 5 days and then 6 g/day orall y for the next 12 months. Left ventricular volumes and ejection fracti on were evaluated on admission, at discharge from hospital and at 3, 6 and 12 months after acute myocardial infarction. Results. A significa nt attenuation of left ventricular dilation in the first year after ac ute myocardial infarction was observed in patients treated with L-carn itine compared with those receiving placebo. The percent increase in b oth end diastolic and end-systolic volumes from admission to 3-, 6- an d 12-month evaluation was significantly reduced in the L-carnitine gro up. No significant differences were observed in left ventricular eject ion fraction changes over time in the two groups. Although not designe d to demonstrate differences in clinical end points, the combined inci dence of death and congestive heart failure after discharge was 14 (6% ) in the L-carnitine treatment group versus 23 (9.6%) in the placebo g roup (p = NS). Incidence of ischemic events during follow-up was simil ar in the two groups of patients. Conclusions. L-Carnitine treatment i nitiated early after acute myocardial infarction and continued for 12 months can attenuate left ventricular dilation during the first year a fter an acute myocardial infarction, resulting in smaller left ventric ular volumes at 3, 6 and 12 months after the emergent event.