Nutritional deficiency cardiomyopathy: A review and pooled analysis of pathophysiology, diagnosis and clinical management

Abstract

The increasing recognition of deficiency of certain essential micronutrients in the failing heart suggests that they may be involved in the pathogenesis of nutritional deficiency cardiomyopathy (NDCM) and ultimately heart failure (HF). Chronic deficits in thiamine, carnitine, selenium, niacin, taurine and Coenzyme Q10 in the myocardial tissues have already been associated with alterations in myocardial energy production, calcium balance or oxidative defences. These pathologic changes may lead to metabolic or myocardial remodelling progressing into NDCM. Due to the severity of potential outcomes of untreated NDCM, it is important for cardiologists to have a good understanding of NDCM. More importantly, NDCM is a treatable phenotype of dilated or hypertrophic cardiomyopathy (CM). Early detection and prompt initiation of nutrient supplementation therapy (NST) has the potential to reverse pathologic myocardial changes and resolve cardiac symptoms. However, current expert consensus guidelines on the treatment of HF do not expressly recommend or are conspicuously silent about the use of NST possibly attributable to inconsistent findings by several small-scale trials and the lack of reliable data by large-scale randomized clinical trials. This review summarizes the existing published data about NDCM with an emphasis on the specific aetiologic micronutrients deficiencies, including their pathophysiology, manifestation, diagnosis and clinical management. This review also identifies gaps in current studies and areas of limited knowledge to move forward with research to fill these critical gaps in knowledge.

A Comprehensive Outlook on Dilated Cardiomyopathy (DCM): State-Of-The-Art Developments with Special Emphasis on OMICS-Based Approaches

“…Low levels of thiamine (B 6 ), carnitine deficiency and hypophosphatemia have a correlation with DCM progression. Nutritional deficiency leads to the abnormal functioning of cardiac muscles and long-term nutritional deficiencies can lead to DCM and other disorders [ 47 ].…”

Implicaciones médicas y nutricionales en insuficiencia cardiaca crónica: fortalezas y limitaciones

“…Las deficiencias crónicas de diversos micronutrimentos pueden favorecer el desarrollo de IC, entre los que se encuentran: coenzima Q10 (CoQ10), tiamina (B1), l-carnitina, taurina y selenio. Estos cinco son componentes esenciales para las vías metabólicas involucradas en la producción de energía, el equilibrio del calcio miocárdico y/o las defensas oxidativas (existen niveles significativamente reducidos en pacientes con IC) 21 .…”

“…El tratamiento primario de la cardiomiopatía por deficiencia de selenio es la suplementación de dicho micronutriente y la nutrición parenteral. Los pacientes con evidencia demostrada de IC podrían recibir carvedilol, un betabloqueador no selectivo que suprime las especies reactivas de oxígeno con efecto antioxidante y antiinflamatorio 21 .…”

Medical and nutritional implications in chronic heart failure: Strengths and limitations

“…Chronic deficiencies of various micronutrients can favor the development of HF, among which some are: coenzyme Q10 (CoQ10), thiamine (B1), L-carnitine, taurine and selenium. These five micronutrients are essential components for the metabolic pathways involved in energy production, myocardial calcium balance and/or oxidative defenses (levels are significantly reduced in patients with HF) 21 .…”

“…Primary treatment of selenium deficiency cardiomyopathy is supplementation of said micronutrient and parenteral nutrition. Patients with confirmed evidence of HF could receive carvedilol, a non-selective beta-blocker that suppresses reactive oxygen species with antioxidant and anti-inflammatory effect 21 .…”