Plasma carnitine as a diagnostic marker at impaired left ventricular function in children with chronic rheumatic heart disease therapeutic role of L-carnitine

ABSTRACT

L-carnitine plays a major role in fatty acid oxidation and myocardial carnitine deficiency may cause malfunction of the head. Chronic rheumatic heart disease [RHD] can be associated with myocardial dysfunction. The objective of this study was to determine if plasma L-carnitine levels can serve as a diagnostic marker of impaired left ventricular [LV] function in children with chronic RHD, and to study the therapeutic role of L-carnitine in these patients. Forty cardiac patients with chronic RHD, with a mean age of 9.0 +/- 2.2 years, were enrolled in the study. They were classified into 2 groups group I [with chronic RHD [20 patients], and group II with chronic RHD with congestive heart failure [CHF] [20 patients]. Twenty healthy children served as a control group. Plasma and urinary levels of L-carnitine were measured using Enzymatic UV test. Echocardiographic assessment of LV systolic function was performed [FS% and EF%]. Clinical and echocardiographic data were studied after 6 months of L-carnitine therapy in a group of 20 patients, compared to non-carnitine therapy group [20 patients]. The results showed that plasma and urinary L-carnitine levels were significantly higher in group II children with chronic RHD with CHF as compared to controls and group I patients [P<0.05]. There were significant negative correlations between plasma carnitine levels and echocardiographic indices of impaired LV systolic function [FS% and EF%] [P<0.05]. There was significant improvement of the clinical characteristics and echocardiographic LV systolic dysfunction, 6 months after L-carnitine therapy [P<0.05]. The elevated plasma [and urinary] L-carnitine levels in children with chronic RHD with CHF, can serve as a diagnostic marker of Impaired LV function. L-carnitine therapy may improve the clinical course and the LV systolic dysfunction in patients with chronic RHD