L-carnitine decreases myocardial injury in children undergoing open-heart surgery: A randomized controlled trial.
- 2024-04-03
- European journal of pediatrics 183(6)
- Wael El Feky
- Dalia El-Afify
- Dina Abdelhai
- Mohamed Elkashlan
- Ahmed Fakhreldin
- Doaa El Amrousy
- PubMed: 38568244
- DOI: 10.1007/s00431-024-05534-2
Study Design
- Type
- Randomized Controlled Trial (RCT)
- Sample size
- n = 60
- Population
- 60 children with congenital heart disease (CHD) who underwent open-heart surgery
- Methods
- Randomized into two groups: L-carnitine group received L-carnitine 50 mg/kg/day once daily for 1 month before cardiac surgery and control group received placebo for 1 month before cardiac surgery. Left ventricular cardiac function assessed by conventional echocardiography (LVEF) and 2D-STE (2D-LV GLS). Blood samples pre-operatively and 12 h post-operatively for MDA, SOD, fas, caspase-3, CK-MB, troponin I.
- Blinding
- Double-blind
- Duration
- 1 month
- Funding
- Unclear
Myocardial injury in open-heart surgery is related to several factors including ischemia-reperfusion injury, generation of reactive oxygen species, increased production of inflammatory mediators, and enhancement of apoptosis of cardiomyocytes. The aim of this study was to study the effect of L-carnitine on myocardial injury in children undergoing open-heart surgery. This clinical trial was performed on 60 children with congenital heart disease (CHD) who underwent open-heart surgery. They were randomized into two groups: L-carnitine group who received L-carnitine 50 mg\kg\day once daily for 1 month before cardiac surgery and control group who received placebo for 1 month before cardiac surgery. Left ventricular cardiac function was assessed by conventional echocardiography to measure left ventricular ejection fraction (LVEF) and two-dimensional speckle tracking echocardiography (2D-STE) to determine left ventricular global longitudinal strain (2D-LV GLS). Blood samples were obtained pre-operatively at baseline before the administration of L-carnitine or placebo and 12 h post-operatively to measure the level of malondialdehyde (MDA), superoxide dismutase (SOD), fas, caspase-3, creatinine kinase-MB (CK-MB), and troponin I. L-carnitine group had significantly lower post-operative level of oxidative stress marker (MDA), apoptosis markers (fas and caspase-3), and myocardial injury markers (CK-MB and troponin I), but they had significantly higher SOD post-operative level compared to the control group. In addition, post-operative LVEF and 2D-LVGLS were significantly lower in the control group compared to L-carnitine group. Conclusion: L-carnitine can reduce myocardial injury, improve post-operative left ventricular cardiac function, and may provide myocardium protection in children with CHD who underwent open-heart surgery. Trial registration: The clinical trial was registered at www.pactr.org with registration number PACTR202010570607420 at 29/10/2020 before recruiting the patients. What is Known: • Myocardial injury in open-heart surgery is related to several factors including ischemia-reperfusion injury, generation of reactive oxygen species, increased production of inflammatory mediators, and enhancement of apoptosis of cardiomyocytes. • L-carnitine was reported to have myocardial protective effects in rheumatic valvular surgery and coronary artery bypass graft (CABG) in adults; however, there is no evidence on its effectiveness in children undergoing open-heart surgery. What is New: • L-carnitine significantly lowered the post-operative level of oxidative stress marker (MDA), apoptosis markers (fas and caspase-3), and myocardial injury markers (CK-MB and troponin I) in the treatment group. • L-carnitine can reduce myocardial injury, improve post-operative left ventricular cardiac function, and may provide myocardium protection in children with CHD who underwent open-heart surgery.
Research Insights
post-operative LVEF and 2D-LVGLS were significantly lower in the control group compared to L-carnitine group.
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery
post-operative LVEF and 2D-LVGLS were significantly lower in the control group compared to L-carnitine group.
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery
but they had significantly higher SOD post-operative level compared to the control group
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery
L-carnitine group had significantly lower post-operative level of ... apoptosis markers (fas and caspase-3)
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery
L-carnitine group had significantly lower post-operative level of ... myocardial injury markers (CK-MB and troponin I)
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery
L-carnitine group had significantly lower post-operative level of ... apoptosis markers (fas and caspase-3)
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery
L-carnitine group had significantly lower post-operative level of oxidative stress marker (MDA), apoptosis markers (fas and caspase-3), and myocardial injury markers (CK-MB and troponin I)
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery
L-carnitine group had significantly lower post-operative level of ... myocardial injury markers (CK-MB and troponin I)
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 50 mg/kg/day once daily for 1 month before cardiac surgery