Wpływ propionylo-L-karnityny na funkcję układu krążenia i metabolizm serca w okresie okołooperacyjnym u chorych z cukrzycą poddanych operacji pomostowania naczyń wieńcowych w krążeniu pozaustrojowym*

*Romuald Lango¹, Piotr Siondalski², Paweł Mroziński¹, Maria Dudziak³, Wiesława Łysiak-Szydłowska⁴, Jan Rogowski², Ryszard Smoleński⁵, Maria Wujtewicz¹

Summary
Background.L-carnitine transports long-chain free fatty acids into the mitochondria. Administration of L-carnitine during ischemia-reperfusion results in an increase in glucose oxidation and a reduction of the elevated intracellular concentration of free fatty acids. Propionyl-L-carnitine is an L-carnitine derivative which enters cardiac myocytes more readily and provides a substrate for the tri-carboxylic acids cycle. The results of experimental and clinical studies indicate that L-carnitine and propionyl-L-carnitine may improve cardiac performance after coronary bypass surgery. The aim of this study was to assess the effect of L-carnitine and propionyl-L-carnitine on myocardial metabolism in the ischaemic/reperfused heart, and on haemodynamic function after cardiopulmonary bypass surgery.
Methods. Seventy diabetic patients with decreased ejection fraction, scheduled for coronary bypass surgery, were randomized to receive either L-carnitine, propionyl-L-carnitine, or placebo in a double-blind manner. The lactate to pyruvate concentration ratio in coronary sinus blood was determined to assess the effect of L-carnitine and propionyl-L-carnitine on myocardial metabolism. Haemodynamic parameters were analyzed in 57 patients – 13 patients in whom postoperative myocardial infarction occurred, or who required intra-aortic balloon counterpulsation were excluded.
Results. The lactate to pyruvate ratio decreased during the early reperfusion phase in patients who received propionyl-L-carnitine, but not those who received L-carnitine or placebo, indicating improved myocardial metabolism. Propionyl-L-carnitine significantly increased cardiac output and oxygen delivery, and reduced pulmonary artery pressure during the early postoperative period.
Conclusion. Propionyl-L-carnitine administration can be regarded as a useful supportive therapy in high-risk diabetic patients after coronary bypass surgery.

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