Abstract-Primary systemic carnitine deficiency is an autosomal recessive disorder caused by a decreased renal reabsorption of carnitine because of mutations of the carnitine transporter OCTN2 gene, and hypertrophic cardiomyopathy is a common clinical feature of homozygotes. Although heterozygotes for OCTN2 mutations are generally healthy with normal cardiac performance, heterozygotes may be at risk for cardiomyopathy in the presence of additional risk factors, such as hypertension. To test this hypothesis, we investigated the effects of surgically induced pressure overload on the hearts of heterozygous mutants of a murine model of OCTN2 mutation, juvenile visceral steatosis mouse (jvs/ϩ). Eleven-week-old jvs/ϩ mice and age-matched wild-type mice were used. At baseline, there were no differences in physical characteristics between wild-type and jvs/ϩ mice. However, plasma and myocardial total carnitine levels in jvs/ϩ mice were lower than in wild-type mice. Both wild-type and jvs/ϩ mice were subjected to ascending aortic constriction with or without 1% L-carnitine supplementation for 4 weeks. At 4 weeks after ascending aortic constriction, jvs/ϩ mice showed an exaggeration of cardiac hypertrophy and pulmonary congestion, further increased gene expression of atrial natriuretic peptide in the left ventricles, further deterioration of left ventricular fractional shortening, reduced myocardial phosphocreatine:adenosine triphosphate ratio, and increased mortality compared with wild-type mice; L-carnitine supplementation prevented these changes in jvs/ϩ mice subjected to ascending aortic constriction. In conclusion, cardiomyopathy and heart failure with energy depletion may be induced by pressure overload in heterozygotes for OCTN2 mutations and could be prevented by L-carnitine supplementation. Key Words: cardiomyopathy Ⅲ genes Ⅲ heart failure Ⅲ hypertension Ⅲ hypertrophy M itochondrial -oxidation of fatty acids is the main source of energy for the heart. 1 Inborn errors in myocardial fatty acid oxidation have been reported to be important causes of inherited cardiomyopathies, which are typically hypertrophic with diminished systolic function. 2 Carnitine is essential for the transport of long-chain fatty acids into the mitochondrial matrix for -oxidation and plays an important role in cellular energy metabolism. 3 Carnitine deficiency leads to energy an metabolism disorder because of impaired fatty acid oxidation. Primary systemic carnitine deficiency (SCD; Online Mendelian Inheritance in Man 212140) is an autosomal recessive disorder caused by decreased renal reabsorption of carnitine because of mutations of the carnitine transporter OCTN2 gene. 4 Progressive cardiomyopathy is a common clinical manifestation of SCD and could be prevented by high-dose L-carnitine supplementation. 5,6 The juvenile visceral steatosis (JVS) mouse was established as an excellent murine model of SCD. 7 SCD in JVS mice is caused by decreased renal reabsorption of carnitine because of a spontaneous mutation in the OCTN2 gene, as has be...