Myocardial infarction and left ventricular remodeling: Results of the CEDIM trial

Left ventricular dilatation after acute myocardial infarction (MI) is a pow erful predictor of progressive functional deterioration, culminating in hea rt failure and death. The most important determinants of post-Mi left ventr icular remodeling are the size of the infarct, the degree of residual steno sis in the infarct-related artery, and the viability of the infarct zone. I n addition to reperfusion therapy and angiotensin-converting enzyme inhibit ion, metabolic intervention with L-carnitine may represent a therapeutic ap proach for preventing left ventricular dilatation and preserving cardiac fu nction. Ongoing studies with early metabolic intervention with carnitine in the acute phase of infarction may prove successful in protecting the micro circulation against ischemic damage and enhancing its ability to respond to blood flow resumption. The results of the multicenter, randomized, double- blind Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) tr ial suggest that the early and long-term administration of L-carnitine atte nuates progressive left ventricular dilatation after acute anterior MI. Res ults show significant, consistent reductions in end-diastolic volume and en d-systolic volume in patients who received L-carnitine compared with placeb o. The ongoing CEDIM-2 trial (projected 4000 patients with acute MI) will a ssess the efficacy of I-carnitine in reducing the combined incidence of dea th and heart failure at 6 months. in addition to standard reperfusion thera py and angiotensin-converting enzyme inhibition, metabolic intervention wit h L-carnitine may be ct therapeutic approach for pro venting left ventricul ar dilatation and preserving cardiac function by limiting infarct size, dec reasing residual stenosis in the infarct-related artery, and increasing via bility of the infarct zone.