Vol 17, No 5 (2010)
Original articles
Published online: 2010-09-23

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

Arturo Orea-Tejeda, Juan José Orozco-Gutiérrez, Lilia Castillo-Martínez, Candace Keirns-Davies, Patricia Montano-Hernández, Oscar Vázquez-Díaz, Adrián Valdespino-Trejo, Oscar Infante, Raúl Martínez-Memije
Cardiol J 2010;17(5):464-470.


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. (Cardiol J 2010; 17, 5: 464-470)

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