Thiamin deficiency and heart failure: the current knowledge and gaps in literature

Abstract

The management of heart failure (HF) represents a significant challenge for both patients as well as the healthcare system in industrialized countries. Thiamin is a required coenzyme in the energy-producing reactions that fuel myocardial contraction. Therefore, thiamin deficiency (TD) may contribute to myocardial weakness by limiting the energy available for contraction. Previous studies have reported a wide range in the prevalence of TD in patients with HF (3-91 %). The impact of thiamin supplementation in patients with HF is inconclusive. Studies conducted to date are limited by their small sample size, indirect methods of assessing thiamin concentration, methodological inconsistencies, use of impractical means of thiamin supplementation, a focus on hospitalized patients, and lack a robust technique for the assessment of cardiac function. Future large prospective studies and randomized controlled trials are needed to improve our understanding of any change in nutritional requirements associated with chronic disease as well as the clinical benefit of supplementation.

Vitamin B1 in critically ill patients: needs and challenges

“…Although cases of beriberi are somewhat of a rarity in modern medicine, there are still populations that are at risk of developing TD. These include patients post-gastric surgery, the elderly, alcoholics, malnourished, diabetics, prolonged hospitalisation, severe fluid loss or fluid replacement therapy [3,15,[67][68][69][70][71].…”

“…Ahmed et al [3] reviewed the prevalence of TD in cardiac failure patients reporting an overall prevalence of 33%-91% in those that are hospitalised and 21%-27% in a consortium of inpatients and outpatients with cardiac failure. Multiple studies have shown improvement with supplementation whilst others show no difference between the disease and non-disease groups [64,73,[82][83][84][85].…”

“…This usually comes standard with modern HPLC equipment -Imprecision must fit within at least the minimum range of biological variation -No data on the commutability of calibrators and standards Post-analytical -No standardised common reference intervals including those for gender, ethnicity and age -No decision limit to determine therapeutic levels difference is transcribed as a percentage increase in transketolase activity; with an increase of around 23% or more indicating TD. However, the upper limit of normal has been greatly debated with published values ranging from 15.5% to 40% of increased activity [3,115]. Further considerations are required when interpreting results from these tests as they are known to be affected by patients with diabetes or liver dysfunction as well as any other condition impeding the synthesis of transketolase [14,115].…”

“…These stores can however become depleted in as little as 18 days after the cessation of thiamine intake [2,3]. This leads to a variety of clinical features that are often vague and sometimes non-specific [4][5][6].…”

“…If this is so, should the measurand be total thiamine (where all thiamine compounds are reduced to form free un-phosphorylated thiamine), or a profile of all thiamine compounds to assess the biological availability of each compound? 3. Finally, what current methodologies allow for the accurate measurement, and therefore clinical interpretation, of thiamine?…”