Treatment with L-carnitine and L-arginine complex therapy patients with acute myocardial infarction

Main Article Content

V. O. Shumakov
N. M. Tereshchenko
O. V. Voloshina
L. P. Tereshkevych
I. E. Malynovska


The aim – to evaluate the effectiveness l-carnitine and l-arginine complex in addition to standard therapy for patients with acute myocardial infarction (AMI).
Materials and methods. The study included 60 patients whose average age was 48.9±19.2 years, with a verified diagnosis of AMI followed percutaneous coronary intervention. The observation period lasted 6 weeks. Patients were randomized into 2 groups. The first group included 30 patients, who received Tivorel (Yuria-Pharm, Ukraine) intravenous infusion of 100 ml once a day in addition to standard therapy, starting from 3–7 days of AMI for 10 days. The second group – 30 patients received only standard therapy (dual antiplatelet therapy, ACE inhibitors, β-blockers, statins). During the study, all patients underwent echocardiography with an assessment of volumetric parameters and ejection fraction (EF, Simpson), end diastolic volume, end systolic volume (ESV), bicycle ergometry, laboratory tests.
Results and discussion. An additional appointment l-carnitine & l-arginine complex leads to a decrease in glucose levels to reference levels 6.1±2.8 mmol/l, in comparison with patients in the control group 7.2±3 3 mmol/l (p<0.05), where the glucose level did not approach the reference range. Creatinine in patients of 1st group compared with the first study was 124.0±20.1 mmol/l, the creatinine level had a significant decrease 103.6±18.1 mmol/l (р<0.005). The creatinine level in patients of 2nd group was 121.2±18.1 and 124.8±17.4 mmol/l in the first and third studies, respectively (p=0.245). The average value of the threshold load power in patients of 1st group reached the mark 107.5±30.9 Wt (р<0.05) compared with 2nd group 99.4±24.9 Wt. The ratio of the difference of the double product to the work performed (ΔDP/A) in response to submaximal physical activity in 1st group on the 15-18th day amoun­­ted to 2.8±1.8, and in 2nd group – 2.4±2.2. Up to 5–6 weeks in 1st group, the ΔDP/A indicator decreased 2.1±0.6 (p<0.05) compared with the ΔDP/A indicator of patients of 2nd group 2.3±1.4 (p=0.145). Thus, exercise tolerance in 1st group after 5–6 weeks became higher than during the first study, that can be regarded as a favorable clinical sign. Indices of intracardiac hemodynamics during the observation period between groups had different trends. So in patients from the 1st group the EF increased to 51.9±5.0 % compared with the first study 48.9±5.9 % (p=0.189) before the second examination, and in patients of the 2nd group, EF to the second study decreased by 45.6±6.2 % compared with the first 48.1±9.2 % (p=0.21). In patients of 1st group, up to 5–6 weeks, a decrease in ESV in 64.0±18.6 ml was recorded compared with the previous study 69.9±21.3 ml (p=0.192), while in the 2nd group this indicator actually remained unchanged. By the end of the study, the difference in this indicator between groups was statistically significant (р<0.05).
Conclusions. Considering that depletion of carnitine and arginine depot during AMI, their deficiency implies the possibility using of l-carnitine and l-arginine complex as a part of combination therapy for patients with AMI. The use of l-carnitine and l-arginine complex on the first 3–15 days of AMI with observation during 6 weeks demonstrated its cardioprotective, nephroprotective and hepatoprotective properties. The positive dynamics of glucose levels and the significant differences between the groups indicate a favorable effect of l-carnitine and l-arginine complex for carbohydrate metabolism

Article Details


myocardial infarction, post-infarction period, cardiorehabilitation, L-arginine, L-carnitine.


Kuzin VM. Karnitina hlorid (25 let v klinicheskoy praktike). Ros. med. zhurn. [Russian Journal of Cardiology]. 2003;10:609–611. (in Russ.)

ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). JACC. 1997;30:260–315.

Amrani M, Gray CC, Smolenski RT, Goodwin AT, London A, Yacoub MH. The effect of L-arginine on myocardial recovery after cardioplegic arrest and ischemia under moderate and deep hypothermia. Circulation 1997;96(Suppl. 9):274–279.

Baudouin SV, Bath P, Martin JF, Du Bois R, Evans TW. L-arginine infusion has no effect on systemic haemodynamics in normal volunteers, or systemic and pulmonary haemodynamics in patients with elevated pulmonary vascular resistance. Br. J. Clin. Pharmacol. 1993;36:45–49.

Bode-Böger SM, Böger RH, Creutzig A, Tsikas D, Gutzki FM, Alexander K, Frölich JC. L-arginine infusion decreases peripheral arterial resistance and inhibits platelet aggregation in healthy subjects. Clin. Sci. 1994;87:303–310.

Böger RH, Mügge A, Bode-Böger SM, Heinzel D, Höper MM, Frölich JC. Differential systemic and pulmonary hemodynamic effects of L-arginine in patients with coronary artery disease or primary pulmonary hypertension. Int. J. Clin. Pharmacol. Ther. 1996;34:323–328.

Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA and EAPCI task force. Europace. 2014;16:1655–1673.

Ceremuzynski L, Chamiec T, Herbaczynska-Cedro K. Effect of supplemental oral L-arginine on exercise capacity in patients with stable angina pectoris. Am. J. Cardiol. 1997;80:331–333.

Clarkson P, Adams MR, Powe AJ, Donald AE, McCredie R, Robinson J, McCarthy SN, Keech A, Celermajer DS, Deanfield JE. Oral L-arginine improves endothelium-dependent dilation in hypercholesterolemic young adults. J. Clin. Invest. 1995;97:1989–1994.

Creager MA, Gallagher SJ, Girerd XJ, Coleman SM, Dzau VJ, Cooke JP. L-arginine improves endothelium-dependent vasodilation in hypercholesterolemic humans. J. Clin. Invest. 1992;90:1248–1253.

DiNicolantonio JJ, Lavie CJ, Fares H, Menezes AR, O'Keefe JH. Carnitine in the Secondary Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis. Mayo Clin Proc. 2013;88(6):544–551.

Drexler H, Fischell TA, Pinto FJ, Chenzbraun A, Botas J, Cooke JP, Alderman EL. Effect of L-arginine on coronary endothelial function in cardiac transplant recipients: Relation to vessel wall morphology. Circulation. 1993;89:1615–1623.

Drexler H, Zeiher AM, Meinzer K, Just H. Correction of endothelial dysfunction in coronary microcirculation of hypercholesterolaemic patients by L-arginine. Lancet.1991;338:1546–1550.

Drosatos K, Schulze PC. Cardiac lipotoxicity: molecular pathways and therapeutic implications. Curr. Heart Fail. Rep. 2013;10(2):109–121.

Eby G, Halcomb WW. Elimination of cardiac arrhythmias using oral taurine with l-arginine with case histories: Hypothesis for nitric oxide stabilization of the sinus node. Med. Hypotheses. 2006;67(5):1200–1204.

Lee R, Nitta T, Schmid RA, Schuessler RB, Harris KM, Gay WA Jr. Retrograde infusion of lidocaine or L-arginine before reperfusion reduces myocardial infarct size. Ann. Thorac. Surg. 1998;65:1353–1359.

Lerman A, Burnett JC Jr, Higano ST, McKinley LJ, Holmes DR Jr. Long-term L-arginine supplementation improves small-vessel coronary endothelial function in humans. Circulation. 1998;97:2123–2128.

Mizuno T, Watanabe M, Sakamoto T, Sunamori M. L-arginine, a nitric oxide precursor, attenuates ischemia-reperfusion injury by inhibiting inositol-1,4,5-triphosphate. J. Thorac. Cardiovasc. Surg. 1998;115:931–936.

Stone GW, Mehran R, Dangas G, Lansky AJ, Kornowski R, Leon MB. Differential Impact on Survival of Electrocardiographic Q-Wave Versus Enzymatic Myocardial Infarction After Percutaneous Intervention: a device-specific analysis of 7147 patients. Circulation. 2011;104(6):642–647.

Tarantini G, Scrutinio D, Bruzzi P, Boni L, Rizzon P, Iliceto S. Metabolic treatment with l-carnitine in acute anterior ST segment elevation myocardial infarction. Cardiology. 2011;106(4):77–84.

Wallace AW, Ratcliffe MB, Galindez D, Kong JS. L-Arginine Infusion Dilates Coronary Vasculature in Patients Undergoing Coronary Bypass Surgery. Anesthesiology. 1999;90(6):1577–1586.

Xu Y, Jiang W, Chen G, Zhu W, Ding W, Ge Z, Tan Y, Ma T, Cui G. L-carnitine treatment of insulin resistance: A systematic review and meta-analysis. Adv. Clin. Exp. Med. 2017;26(2):333–338.

Most read articles by the same author(s)