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Amino acids and derivatives, a new treatment of chronic heart failure?

Abstract

Amino acids play a key role in multiple cellular processes. Amino acids availability is reduced in patients with heart failure (HF) with deleterious consequences on cardiac and whole-body metabolism. Several metabolic abnormalities have been identified in the failing heart, and many of them lead to an increased need of amino acids. Recently, several clinical trials have been conducted to demonstrate the benefits of amino acids supplementation in patients with HF. Although they have shown an improvement of exercise tolerance and, in some cases, of left ventricular function, they have many limitations, namely small sample size, differences in patients’ characteristics and nutritional supplementations, and lack of data regarding outcomes. Moreover recent data suggest that a multi-nutritional approach, including also antioxidants, vitamins, and metals, may be more effective. Larger trials are needed to ascertain safety, efficacy, and impact on prognosis of such an approach in HF.

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Abbreviations

6MWD:

6-min walking distance

AAs:

Amino acids

ATP:

Adenosine triphosphate

BID:

Twice daily

BMI:

Body mass index

BW:

Body weight

CAD:

Coronary arteries disease

CHF:

Chronic heart failure

COPD:

Chronic obstructive pulmonary disease

CRP:

C-reactive protein

GH:

Growth hormone

HF:

Heart failure

HFpEF:

Heart failure preserved ejection fraction

IGF-1:

Insulin-like growth factor 1

IL-1:

Interleukin 1

IV:

Intravenous

LVEDD:

Left ventricle end-diastolic diameter

LVEDV:

Left ventricle end-diastolic volume

LVEF:

Left ventricle ejection fraction

LVESV:

Left ventricle end-systolic volume

MET:

Metabolic equivalent

MLWHFQ:

Minnesota Living With Heart Failure Questionnaire

NO:

Nitric oxide

NOS:

Nitric oxide synthase

NYHA:

New York Heart Association

OD:

Once daily

sPAP:

Systolic pulmonary artery pressure

RVEF:

Right ventricle ejection fraction

TID:

Three times daily

TNF-α:

Tumor necrosis factor α

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Correspondence to Marco Metra.

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Marco Metra has received honoraria from Abbott Vascular, Amgen, Bayer, Novartis, Servier for participation at advisory board meetings and Committees for ongoing trials.

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Carubelli, V., Castrini, A.I., Lazzarini, V. et al. Amino acids and derivatives, a new treatment of chronic heart failure?. Heart Fail Rev 20, 39–51 (2015). https://doi.org/10.1007/s10741-014-9436-9

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Keywords

  • Heart failure
  • Chronic heart failure
  • Nutrition
  • Essential amino acids
  • Amino acids
  • Supplementation