Title : Integrative metabolic therapeutic approach for symptomatic patients with left ventricular dilatation and reduced ejection fraction
Abstract: Introduction & Aim: Myocardial energetics has a central role in the pathophysiology of heart failure. Our hypothesis was that cardiac metabolic therapeutic approach must be integrative, improving both the substrate utilization and the complete substrate oxidation, i.e. supporting normal mechanism of energy production without increased generation of reactive oxygen species. Since the energy metabolism is closely linked to cardiac function, we assessed the effect of the integrative metabolic approach on the functional ability and quality of life in patients with heart failure and reduced ejection fraction /HFrEF/.
Methods and results: We investigated 33 patients with left ventricular dilatation /LVIDd>60 mm/ and reduced ejection fraction /EF<40%/ in 76 complementary supportive therapy /CST/ periods. Prior to each CST period,therapy was optimized /OMT/ for one month. CST consisted of a 10-day session. In addition to OMT,the patients were treated with carnitine, L-arginine, magnesium, vitamin B, coenzyme Q-10, vitamin E, vitamin C and selenium while lying for 30 minutes inside a pulsed electromagnetic field with intensity of up to 30 microteslas and inhaling negatively ionized oxygen. Before and after each CST period, patients were asked to evaluate the quality of life using the Minnesota Living with Heart Failure Questionnaire /MLHFQ/ and the visual analogue scale /VAS/, EF, LVIDd and NYHA classes were determined. Statistical analysis was based on the t-test, Spearman's rank correlation coefficient and Wilcoxon's signed-ranks test. The longest observation period was 122 months.
After administering the metabolic supportive therapy, a statistically significant improvement /p<0,05/ was noticed in particular items of the MLHFQ, in emotional and physical dimensions. The values of VAS and EF increased whereas the values of NYHA and LVIDd decreased significantly /p<0,001/.
Conclusion: Integrative metabolic therapeutic approach significantly improved the functional capacity and quality of life in patients with HFrEF.