We examined plasma levels of free L-carnitine as well as several of its precursors and derivates in HF patients (n = 183) and matched healthy controls (n = 111) as well as their relationship with cardiac dysfunction as assessed by echocardiographic measurements, inflammation (CRP) and neurohormonal activation (NT-proBNP) in addition to the prognostic value of carnitine derivates in relation to mortality in these patients. High levels of the carnitine derivates acetyl-carnitine and in particular palmitoyl-carnitine were associated with the degree of HF as evaluated by clinical (NYHA functional class) and neurohormonal assessments. Moreover, plasma levels of palmitoyl-carnitine were associated with serious adverse events (i.e., all-cause mortality and heart transplantation) during follow-up, independently of more established risk markers such as CRP and NT-proBNP, when analyzed by cox-regression and continous net reclassification improvement, but not c-statistics.
Our findings support a role for disturbed carnitine metabolism in the pathogenesis of HF, and suggest that some of its derivates could give prognostic information in these patients.