923-2 Effects of L-Carnitine on Left Ventricular Function After Acute Myocardial Infarction. Results of the CEDIM (Carnitina Ecocardiografia Digitale Infarto Miocardico) Trial

Limitation of left ventricular (LV) dilatation (LV remodeling) after acute myocardial infarction (AMI) has become an essential therapeutic goal since the entity of LV dilatation after AMI is now recognized to be the most powerful prognostic predictor for clinical outcome. L-Carnitine (L-C) is an essential compound of cardiac metabolism that favours the optimal utilization of energetic substrates. Experimental studies have demonstrated that L-C administration during and after myocardial ischemia restores L-C cardiac depletion following ischemia and exerts a beneficial effect on LV function. To test the hypothesis, that timely restoration of adequate intracardiac L-C levels after AMI could limit LV dilatation on a long-term basis in a clinical setting, a multicenter, randomized, double-blind, placebo controlled trial was undertaken (CEDIM trial). 472 pts with first, anterior AMI and high quality entry 20 echo were enrolled (370/472 pts underwent thrombolysis). Pts were randomized to placebo (PI) or L-C (6g/day iv for the first 5 days and 9g/day orally for the following 12 months). 20 echo was digitally performed on admission, at 3, 6, 12 months after AMI. 2D echo images were transmitted via modem using a long-distance network to a Core Laboratory where end-diastolic and endsystolic volumes (EDV, ESV) were assessed. Baseline clinical and echocardiographic characteristics were similar in L-C and PI groups. Percent variation (Δ %) of EDV and ESV at 3, 6,12 months from baseline was evaluated in both PI and L-C groups.Results:3 months6 months12 monthsΔ%-EDVL-C11.1±30.212.7±26.819.1±36.2PI18.0±33.0*19.5±30.6*28.5±40.2*Δ%-ESVL-C12.6±41.615.1±36.828.9±51.4PI22.5±42.8*25.6±42.3**39.9±55.1**p<0.05.**p=0.01 (Student's t test L-C vs PI)Congestive heart failure developed in 10 pts (4.2%) on PI vs 4 pts (1.7%) on L-C.ConclusionTimely administration of L-C after AMI limits LV dilatation in the first year after AMI and, therefore, represents a new approach to optimize LV remodeling after AMI