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On the other hand, in HF patients, cardiac energy metabolism is shifted from fatty acid oxidation to glucose, and carnitine insufficiency in the failing myocardium is caused by the leakage of carnitine through damaged cardiomyocyte membranes [4]

One of the enzymes in this pathway, -butyrobetaine hydroxylase, is absent from cardiac and skeletal muscle but highly expressed in human liver, testes, and kidney [4]