The effect of L-arginine and citrulline on endothelial function in patients in heart failure with preserved ejection fraction

Cardiol J. 2010;17(5):464-70.

Abstract

Background: To evaluate the effect of the amino acids L-arginine and citrulline on endothelial function in patients in stable diastolic and right heart failure using photoplethysmography.

Methods: Thirty patients from the Heart Failure Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" underwent photoplethysmography using the hyperemia technique. Index finger flow was assessed at baseline and after ischemia every 30 s by maximum amplitude time (MAT), total time of the curve (TT) and the index of the two (MAT/TT < 30 = normal) before and after the administration of L-arginine (8 g/day in two doses, n = 15) or citrulline (3 g/day in one dose, n = 15) for 60 days in addition to optimal pharmacological treatment.

Results: There were no statistically significant differences between the two groups at baseline. After the intervention, the MAT/TT index of all patients normalized in each evaluation period with statistically significant differences. Basal L-arginine group = 38.75 ± 11.52, final 23.32 ± 6.08, p = 0.007 and basal citrulline group = 41.4 ± 13.47, final 23.65 ± 6.74, p = 0.007 at 60-90 s. Post-ischemia: basal L-arginine 36.60 ± 11.51, final 18.81 ± 15.13, p = 0.004 and basal citrulline = 49.51 ± 15.17, final 27.13 ± 7.87, p = 0.003.

Conclusions: The administration of L-arginine and citrulline has a beneficial effect on endothelial function as shown by the normalized MAT/TT index. It probably improves systemic and pulmonary hemodynamics, which could help in the treatment of diastolic heart failure.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Arginine / administration & dosage*
  • Citrulline / administration & dosage*
  • Echocardiography
  • Endothelium, Vascular / drug effects*
  • Endothelium, Vascular / physiology
  • Female
  • Fingers / blood supply
  • Heart Failure / diagnostic imaging
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Heart Failure, Diastolic / diagnostic imaging
  • Heart Failure, Diastolic / drug therapy*
  • Heart Failure, Diastolic / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Photoplethysmography
  • Stroke Volume / physiology*
  • Vasodilation / drug effects
  • Vasodilation / physiology

Substances

  • Citrulline
  • Arginine