title: Improvement of ventricular function in systolic heart failure patients with oral L-citrulline supplementation.
abstract: BACKGROUND
  The utility of L-arginine and L-citrulline in treatment of arterial hypertension by increasing vascular oxide nitric availability has been demonstrated. Photoplethysmography, a simple and low-cost optical technique, makes it possible to assess vascular function and to detect changes in blood flow, pulse and swelling of the microvascular tissular space. The aim of the study was to evaluate the effect of L-citrulline supplementation on functional class, ejection fraction and peripheral blood flow in patients with systolic heart failure.
  
  
  METHODS
  Thirty-five stable outpatients attending the Heart Failure Clinic at the INCMNSZ underwent clinical evaluation, radioisotopic ventriculography and photoplethysmography before and at the end of 4 months. They were randomized into two groups: experimental group, with oral L-citrulline supplementation (3 g/day, n = 20) and control group, without supplementation (n = 15).
  
  
  RESULTS
  In the experimental group the left ventricular ejection fraction (LVEF) increased 20.3% at rest and 12.7% with stress, as well as the right ventricular ejection fraction at rest of 15.10% and 14.88% with stress. In addition, functional class improved in 35%, and the maximum amplitude time/total time (MAT/TT) index decreased 23.1%. These changes were statistically significant compared with the control group.
  
  
  CONCLUSIONS
  Citrulline supplementation significantly improved the LVEF, the endothelial function (MAT/TT index) and functional class. Citrulline can be an important co-adjuvant in the treatment of stable and stable systolic heart failure patients.
authors.affiliation: Instituto nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico, Mexico.
authors.forename: Karla
authors.initials: K
authors.lastname: Balderas-Munoz
authors.forename: Lilia
authors.initials: L
authors.lastname: Castillo-Martínez
authors.forename: Arturo
authors.initials: A
authors.lastname: Orea-Tejeda
authors.forename: Oscar
authors.initials: O
authors.lastname: Infante-Vázquez
authors.forename: Marcelo
authors.initials: M
authors.lastname: Utrera-Lagunas
authors.forename: Raúl
authors.initials: R
authors.lastname: Martínez-Memije
authors.forename: Candace
authors.initials: C
authors.lastname: Keirns-Davis
authors.forename: Bryan
authors.initials: B
authors.lastname: Becerra-Luna
authors.forename: Gabriela
authors.initials: G
authors.lastname: Sánchez-Vidal
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001120:Arginine / Q000008:administration & dosage*; D016022:Case-Control Studies; D002956:Citrulline / Q000008:administration & dosage*; D019587:Dietary Supplements; D004730:Endothelium, Vascular / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D010045:Outpatients; D017156:Photoplethysmography; D011877:Radionuclide Imaging; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D002956:Citrulline; D009569:Nitric Oxide; D001120:Arginine