Key result
IV levocarnitine is linked to improved LV systolic and diastolic function in hemodialysis patients.
Why the study?
Levocarnitine is known to improve LV systolic function and reduce LV hypertrophy in hemodialysis patients, but its effect on LV diastolic dysfunction has not been clarified.
Does long-term intravenous levocarnitine administration improve left ventricular diastolic and systolic function in hemodialysis patients?
Cohort (n=88)
Yes
Does long-term intravenous levocarnitine administration improve left ventricular diastolic and systolic function in hemodialysis patients?
Intravenous levocarnitine supplementation post-dialysis may ameliorate underlying left ventricular diastolic and systolic dysfunction in hemodialysis patients.
May support levocarnitine in hemodialysis cardiac dysfunction; hypothesis-generating pending randomized confirmation.
Background: Levocarnitine has been reported to improve the left ventricular (LV) systolic function and decrease LV hypertrophy in hemodialysis (HD) patients. Its effect on LV diastolic dysfunction, however, has not yet been clarified. Methods and Results: HD patients (n=88) were given levocarnitine i.v. 1,000 mg for 12 months at the end of every dialysis session through the dialysis circuit of the venous site. LV ejection fraction (EF), E/A, E/e’, left atrial volume index (LAVI) and LV mass index (LVMI) were measured before and 3, 6, 9, and 12 months after the start of levocarnitine on echocardiography. We regarded E/A≤0.8, E/e’>14 and LAVI>34 mL/m2 as LV diastolic dysfunction, and LVEF<55% as LV systolic dysfunction. We also investigated the effect of levocarnitine on HFpEF. Plasma brain natriuretic peptide, total carnitine, free carnitine, and acyl-carnitine and biochemistry parameters were measured. Levocarnitine significantly improved LV diastolic function in HD patients with LV diastolic dysfunction, but did not affect LV diastolic function in those with normal LV diastolic function. Levocarnitine significantly improved HFpEF. Levocarnitine significantly improved the LV systolic function in HD patients with LV systolic dysfunction but did not affect the LV systolic function in those with normal LV systolic function. Levocarnitine significantly decreased LVMI and increased plasma total, free, and acyl-carnitine. Conclusions: Levocarnitine ameliorates LV diastolic as well as LV systolic dysfunction in HD patients.
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Naito et al. (2019) conducted a cohort in Hemodialysis with or without left ventricular dysfunction (n=88). Levocarnitine vs. Baseline values / Concurrent cohort with normal LV function was evaluated on Change in left ventricular diastolic and systolic function parameters (LVEF, E/A, E/e', LAVI) at 12 months. Intravenous levocarnitine administered for 12 months significantly improved both left ventricular diastolic and systolic echocardiographic parameters in hemodialysis patients with baseline cardiac dysfunction.
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