n the study of Silverman et al. carnitine supplementation had a positive and dose-dependent effect on preserving ventricle compliance and contractility of ischemic canine heart muscle, yet had no influence upon a decrease in ATP concentration induced by ischemia [25]. In another study, when oxygenated blood supply was restored, no recovery of lipid oxidation was observed unless carnitine deficiency had been compensated [29]. According to Liedtke et al. reduced carnitine reserves in the myocardium strengthen the negative influence of lipids and particularly of free fatty acids, on heart metabolism [29]. The positive carnitine influence seen in acute myocardial ischemia was explained by limiting a decrease in high-energy phosphates [30] and some improvement in glucose oxidation and lactate extraction [31]. Basic metabolic effects of carnitine supplementation during ischemia–reperfusion and its suggested clinical effects are presented in Fig. 2.