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Effect of L-carnitine on heart rate and QTс in patients with acute coronary syndrome

Glezer M. G., Kiseleva A. E., Astashkin E. I.
State Budgetary Educational Institution, "I. M. Sechenov First Moscow State Medical University" at the RF Ministry of Health Care, Trubetskaya 8, Bld.2, Moscow 119991

Keywords: L-carnitine, corrected QT, ACS, heart rate

DOI: 10.18087/rhj.2015.2.2072

Aim. To evaluate the capability of L-carnitine for QT correction in patients with acute coronary syndrome (ACS). Materials and methods. This prospective, double-blind, randomized, placebo-controlled study included 58 patients with ACS who have not undergone surgical interventions (29 patients in the L-carnitine treatment group and 29 patients in the placebo group). L-carnitine 2 g i.v., was administered twice daily during the first 3 days and 2 g once daily – from day 4 through day 15 (or until discharge from the hospital if occurred earlier). The QT interval was measured on days 1, 2, 3, 5, 7, and 12–14 of the disease in standard lead II for at least three successive cycles; mean values were calculated. The values were corrected for the heart rate (HR) according to the Bazett formula (QTc). Results. The compared groups did not differ in their baseline characteristics. Reduced HR and QTc values were observed in both groups. However, in the placebo group, the QTc decrease was not significant (from 439.1±36.9 msec to 422.9±27.7 msec at days 12–14 of ACS). In the L-carnitine treatment group, the QTc decrease from day 1 to days 12–14 of disease was significant (from 457.5±39.5 msec to 413.2±30.5 msec; p<0.00001). In the L-carnitine group, the decrease was significantly greater at all observation points, and at days 12–14 it reached 9.3±7.3 % vs. –2.0±8.2 % in the placebo group (р=0.002). The decrease in QTc was greater for patients with the baseline QTc duration above 440 msec. In the L-carnitine group, significant decreases were observed from the first day of disease whereas in the placebo group – only by day 7 of disease. When baseline QTc was shorter than 440 msec, significant decreases were observed in the L-carnitine group by day 7 of disease whereas changes were absent in the placebo group. In patients with MI, significant QTc changes in response to the L-carnitine treatment were observed from the first day of disease, and the magnitude of the QTc decrease was significantly different from QTc changes in the placebo group. The QTc decrease was not significant in patients with unstable angina. Conclusion. L-carnitine restricted changes in the corrected QT interval, the marker for high risk of unfavorable events, in ACS patients.
  1. Reardon M, Malik M. QT interval change with age in an overtly healthy older population. Clin Cardiol.1996 Dec;19 (12):949–52.
  2. Molnar J, Zhang F, Weiss J et al. Diurnal pattern of QTc interval: how long is prolonged? Possible relation to circadian triggers of cardiovascular events. J Am Coll Cardiol. 1996 Jan;27 (1):76–83.
  3. Beyerbach DM, Kovacs RJ, Dmitrienko AA et al. Heart rate-corrected QT interval in men increases during winter months. Heart Rhythm. 2007 Mar;4 (3):277–81.
  4. Elming H, Holm E, Jun L et al. The prognostic value of the QT interval and QT interval dispersion in all-cause and cardiac mortality and morbidity in a population of Danish citizens. Eur Heart J. 1998 Sep;19 (9):1391–400.
  5. de Bruyne MC, Hoes AW, Kors JA et al. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study. Eur Heart J. 1999 Feb;20 (4):278–84.
  6. Dekker JM, Crow RS, Hannan PJ et al. Heart rate-corrected QT interval prolongation predicts risk of coronary heart disease in black and white middle-aged men and women – the ARIC study. J Am Coll Cardiol. 2004 Feb 18;43 (4):565–71.
  7. Chugh SS, Reinier K, Singh T et al. Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study. Circulation. 2009 Feb 10;119 (5):663–70.
  8. Swynghedauw B, Baillard C, Milliez P. The long QT interval is not only inherited but is also linked to cardiac hypertrophy. J Mol Med (Berl). 2003 Jun;81 (6):336–45.
  9. Panikkath R, Reinier K, Uy-Evanado A et al. Electrocardiographic predictors of sudden cardiac death in patients with left ventricular hypertrophy. Ann Noninvasive Electrocardiol. 2013 May;18 (3):225–9.
  10. Soliman EZ, Shah AJ, Boerkircher A et al. Inter-relationship between electrocardiographic left ventricular hypertrophy and QT prolongation as predictors of increased risk of mortality in the general population. Circ Arrhythm Electrophysiol. 2014 Jun;7 (3):400–6.
  11. Narayanan K, Reinier K, Teodorescu C et al. Electrocardiographic versus echocardiographic left ventricular Hypertrophy and sudden cardiac arrest in the community. Heart Rhythm. 2014 Jun;11 (6):1040–6.
  12. Verma A, Meris A, Skali H et al. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study. JACC Cardiovasc Imaging. 2008 Sep;1 (5):582–91.
  13. Sievi NA, Clarenbach CF, Camen G et al. High prevalence of altered cardiac repolarization in patients with COPD. BMC Pulm Med. 2014 Apr 2;14:55.
  14. Panoulas VF, Toms TE, Douglas KM et al. Prolonged QTc interval predicts all-cause mortality in patients with rheumatoid arthritis: an association driven by high inflammatory burden. Rheumatology (Oxford). 2014 Jan;53 (1):131–7.
  15. Schwartz PJ, Wolf S. Q-T interval prolongation as predictor sudden death in patients with miocsrdial infarction. Circulation. 1978 Jun;57 (6):1074–7.
  16. Gadaleta F, Llois S, Kaski JC. Corrected QT interval: a prognostic marker in patients with non-ST-segment elevation acute coronary syndrome? Trends Cardiovasc Med. 2011 Jul;21 (5):129–35.
  17. Karwatowska-Prokopczuk E, Wang W, Cheng ML et al. The risk of sudden cardiac death in patients with non-ST elevation acute coronary syndrome and prolonged QTc interval: effect of ranolazine. Europace. 2013 Mar;15 (3):429–36.
  18. Глезер М. Г. Киселева А. Е., Асташкин Е. И. Влияние L-карнитина на дисперсию интервала QT у пациентов с острым коронарным синдромом. Кардиология 2015; 3:4–9
  19. Ahnve S, Helmers C, Lundman T. QTc intervals at discharge after acute myocardial infarction and long-term prognosis. Acta Med Scand. 1980;208 (1-2):55–60.
  20. Асташкин Е. И., Глезер М. Г. Роль L-карнитина в энергетическом обмене кардиомиоцитов и лечении заболеваний сердечно-сосудистой системы. Кардиология и сердечно-сосудистая хирургия. 2012;6:58–65.
  21. Sakata K, Hayashi H, Kobayashi A, Yamazaki N. Mechanism of arrhythmias induced by palmitoylcarnitine in guinea pig papillary muscle. Cardiovasc Res. 1989 Jun;23 (6):505–11.
  22. Singh RB, Niaz MA, Agarwal P et al. A randomized, double-blind, placebo controlled trial of L-carnitine in suspected myocardial infarction. Postgrad Med J. 1996 Jan;72 (843):45–50.
  23. Tarantini G, Scrutinio D, Bruzzi P et al. Metabolic treatment with L-carnitine in acute anterior ST segment elevation myocardial infarction. A randomized controlled trial. Cardiology. 2006;106 (4):215–23.
  24. DiNicolantonio JJ, Lavie CJ, Fares H et al. L-carnitine in the secon­dary prevention of cardiovascular disease: systematic review and meta-analysis. Mayo Clin Proc. 2013 Jun;88 (6):544–51.
  25. Martina B, Zuber M, Weiss P et al. Anti-arrhythmia treatment using L-carnitine in acute myocardial infarct. Schweiz Med Wochenschr. 1992 Sep 12;122 (37):1352–5.
  26. Rizzon P, Biasco G, Di Biase M et al. High doses of L-carnitine in acute myocardial infarction: metabolic and antiarrhythmic effects. Eur Heart J. 1989 Jun;10 (6):502–8.
  27. Dinicolantonio JJ, Niazi AK, McCarty MF et al. L-carnitine for the treatment of acute myocardial infarction. Rev Cardiovasc Med. 2014;15 (1):52–62.
Glezer M. G., Kiseleva A. E., Astashkin E. I. Effect of L-carnitine on heart rate and QTс in patients with acute coronary syndrome. Russian Heart Journal. 2015;14 (2):78–84

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