Influence of L-carnitine and its derivatives on myocardial metabolism and function in ischemic heart disease and during cardiopulmonary bypass

Carnitine and its derivatives have recently been shown to protect cardiac m etabolism and function in ischemic heart disease and other clinical conditi ons of myocardial ischemia. Potential mechanisms of this effect include an increase in glucose metabolism, a reduction of toxic effects of long-chain acyl-CoA and acyl-carnitine in myocytes, an increase in coronary blood Row and anti-arrhythmic effect, It has also been shown that propionyl-L-carniti ne which penetrates faster than carnitine into myocytes is effective in inh ibiting production of free radicals. Beneficial effects of carnitine supple mentation have been demonstrated under a variety of clinical conditions suc h as acute cardiac ischemia, during extracorporeal circulation, in carnitin e-dependent cardiomyopathy as well as in patients with chronic circulatory failure and in cardiogenic shock. However, further studies are required bef ore carnitine administration could be recommended as a routine procedure in ischemic heart disease or before cardiopulmonary bypass. (C) 2001 Publishe d by Elsevier Science B.V.