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The role of nutritional supplementation with essential amino acids in patients with chronic heart failure


Essential amino acid supplementation (EAS) may counteract hypercatabolic states, such as chronic heart failure (CHF). This pilot study investigated whether EAS could improve quality of life (QoL), cardiac function and exercise tolerance in patients (pts) with stable CHF on optimal medical treatment (OMT). We enrolled 27 pts (21 males) with ejection fraction (EF) <35% and on OMT with no changes within the previous 6 months. EAS, composed of leu (1,250 mg), lys (650 mg), ile (625 mg), val (625 mg), thr (350 mg), cys (150 mg), his (150 mg), phe (100 mg), met (50 mg), t4 (30 mg), trp (20 mg), B1 (0.15 mg) and B6 (0.15 mg) vitamins, was given twice a day for 3 months. At baseline and after 3 months, we evaluated symptoms with NYHA classification, LVD36 questionnaire and QoL scale; cardiac function by echocardiography and exercise tolerance (modified Bruce protocol); pro-BNP, renal function, glucose and troponin. We observed a significant reduction of end-systolic and diastolic volumes (ESV 121.6 ± 63.08 vs. 106.82 ± 50.1 mL, p = 0.018; EDV 169.1 ± 75.3 vs. 150 ± 67.5 mL, p < 0.02), an increase of EF (29.8 ± 5.7 vs. 35.4 ± 5.8%, p < 0.001) and of cardiac output (5.58 ± 1.57 vs. 6.07 ± 1.66 L/min; p = 0.015). We assisted a no significant trend toward reduction in mitral regurgitation (p = 0.3). EAS improved QoL (NYHA p < 0.001; LVD36 14.1 ± 7.2 vs. 12.2 ± 6.9, p = 0.015; QoL scale 62.4 ± 12.5 vs. 74 ± 9.7%, p < 0.001); exercise tolerance (stage 3.24 ± 1.3 vs. 3.57 ± 1.3, p = 0.016; METS 6.6 ± 3.4 vs. 7.1 ± 3.3, p = 0.18; Minutes 8.1 ± 4.29 vs. 8.7 ± 3.94, p = 0.055). No changes in glucose, creatinine, cholesterol, troponin and a no significant trend toward reduction of pro-BNP was observed (1,077.4 ± 530.3 vs. 851.6 ± 315.1 ng/l, p = 0.3). No pts showed adverse effects. After 3 months, EAS significantly improves cardiac function, QoL and exercise tolerance in stable CHF pts.

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  1. 1.

    Lainscak M, Filippatos GS, Gheorghiade M, Fonarow GC, Anker SD (2008) Cachexia: common, deadly, with an urgent need for precise definition and new therapies. Am J Cardiol 101(11A):8E–10E

    Article  Google Scholar 

  2. 2.

    Redfield MM (2002) Heart failure—an epidemic of uncertain proportions. N Engl J Med 347(18):1442–1444

    Article  Google Scholar 

  3. 3.

    Levy D, Kenchaiah S, Larson MG, Benjamin EJ, Kupka MJ, Ho KK, Murabito JM, Vasan RS (2002) Long-term trends in the incidence of and survival with heart failure. N Engl J Med 347(18):1397–1402

    Article  Google Scholar 

  4. 4.

    Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole-Wilson PA, Sutton GC, Grobbee DE (1997) The epidemiology of heart failure. Eur Heart J 18(2):208–225

    CAS  Google Scholar 

  5. 5.

    Van Jaarsveld CH, Ranchor AV, Kempen GI, Coyne JC, van Veldhuisen DJ, Sanderman R (2006) Epidemiology of heart failure in a community-based study of subjects aged > or = 57 years: incidence and long-term survival. Eur J Heart Fail 8(1):23–30

    Article  Google Scholar 

  6. 6.

    Zoghbi WA (2002) Evaluation of myocardial viability with contrast echocardiography. Am J Cardiol 90(10A):65J–71J

    Article  Google Scholar 

  7. 7.

    Chaudhry FA, Tauke JT, Alessandrini RS, Vardi G, Parker MA, Bonow RO (1999) Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol 34(3):730–738

    CAS  Article  Google Scholar 

  8. 8.

    Stanley WC, Chandler MP (2002) Energy metabolism in the normal and failing heart: potential for therapeutic interventions. Heart Fail Rev 7(2):115–130

    CAS  Article  Google Scholar 

  9. 9.

    Stanley WC, Hoppel CL (2000) Mitochondrial dysfunction in heart failure: potential for therapeutic interventions? Cardiovasc Res 45(4):805–806

    CAS  Article  Google Scholar 

  10. 10.

    Kalantar-Zadeh K, Anker SA, Horwich TB, Fonarow GC (2008) Nutritional and anti-inflammatory interventions in chronic heart failure. Am J Cardiol 101(11A):89E–103E

    CAS  Article  Google Scholar 

  11. 11.

    Scognamiglio R, Negut C, Palisi M, Dioguardi FS, Coccato M, Iliceto S (2008) Effects of oral amino acid supplements on cardiac function and remodeling in patients with type 2 diabetes with mild-to-moderate left ventricular dysfunction. Am J Cardiol 101(11A):111E–115E

    CAS  Article  Google Scholar 

  12. 12.

    Aquilani R, Viglio S, Iadarola P, Opasich C, Testa A, Dioguardi FS, Pasini E (2008) Oral amino acid supplements improve exercise capacities in elderly patients with chronic heart failure. Am J Cardiol 101(11A):104E–110E

    CAS  Article  Google Scholar 

  13. 13.

    Neubauer S (2007) The failing heart—an engine out of fuel. N Engl J Med 356(11):1140–1151

    Article  Google Scholar 

  14. 14.

    Flati V, Pasini E, D’Antona G, Speca S, Toniato E, Martinotti S (2008) Intracellular mechanisms of metabolism regulation: the role of signaling via the mammalian target of rapamycin pathway and other routes. Am J Cardiol 101(11A):16E–21E

    CAS  Article  Google Scholar 

  15. 15.

    Nisoli E, Cozzi V, Carruba MO (2008) Amino acids and mitochondrial biogenesis. Am J Cardiol 101(11A):22E–25E

    CAS  Article  Google Scholar 

  16. 16.

    Pasini E, Aquilani R, Dioguardi FS, D’Antona G, Gheorghiade M, Taegtmeyer H (2008) Hypercatabolic syndrome: molecular basis and effects of nutritional supplements with amino acids. Am J Cardiol 101(11A):11E–15E

    CAS  Article  Google Scholar 

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Correspondence to I. Franzoni.

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Macchi, A., Franzoni, I., Buzzetti, F. et al. The role of nutritional supplementation with essential amino acids in patients with chronic heart failure. Mediterr J Nutr Metab 3, 209–214 (2010).

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  • Essential amino acids supplementation
  • Chronic heart failure
  • Hypercatabolism
  • Cachexia