Myocardial Free Carnitine and Fatty Acylcarnitine Levels in Patients with Chronic Heart Failure

To study the tissue carnitine level in patients with chronic heart failure, we obtained biopsy specimens of the left ventricular papillary muscle from 8 patients with mitral valve disease undergoing valve replacement surgery. As a control group autopsy specimens from 7 patients without heart disease were obtained within 4 hours of death. The free carnitine level in the heart was significantly lower in patients with chronic heart failure than in the control group (412 +/- 142 nmol/g wet tissue vs 769 +/- 267; p less than 0.01, mean +/- SD). The long-chain acylcarnitine level was significantly higher in chronic heart failure than in the control group (532 +/- 169 nmol/g wet tissue vs 317 +/- 72; p less than 0.01). The total carnitine level in chronic heart failure was similar to that in the control group (1321 +/- 170 nmol/g wet tissue vs 1315 +/- 377). These results show that in failing myocardium the fatty acid metabolism may be impaired, and administration of carnitine may be worth trying to treat chronic heart failure.