Thiamine Supplementation for the Treatment of Heart Failure: A Review of the Literature

Abstract

A systematic review of the literature was performed by searching Pubmed and EMBASE databases using the terms “thiamine,” “vitamin B1,” “heart failure,” “systolic dysfunction,” “ventricular dysfunction,” “cardiomyopathy,” “ventricular failure,” and “systolic failure.” Relevant trials and articles were evaluated pertaining to thiamine deficiency in patients with heart failure (HF) and references were searched for further inclusion of articles. A total of 20 articles were reviewed and summarized in detail. While more research is needed to fully elucidate the clinical thiamine deficiency in HF patients, recent evidence has indicated that supplementing with thiamine in HF patients has the potential to improve left ventricular ejection fraction. Thiamine deficiency appears to be not uncommon in patients with HF, and supplementation with thiamine has been shown to improve cardiac function, urine output, weight loss, and signs and symptoms of HF. Therefore, this simple therapy should be tested in large‐scale randomized clinical trial to further determine the effects of thiamine in HF patients.

ASPEN Consensus Recommendations for Refeeding Syndrome

“…Inadequate ATP production in cardiac tissue can lead to release of adenosine into the plasma. Adenosine causes peripheral vasodilatation, elevated cardiac output, decreased cardiac contractility, dysrhythmias, and low diastolic blood pressure 37‐39 …”

Benfothiamine Administration in Patients with Dilated Cardiomyopathy and Advanced Heart Failure with Chronic Diuretic Treatment

“…By preventing cardiomyocyte apoptosis, myocardial fibrosis and microvascular rarefaction in diabetic experimental hearts, benfotiamine improved their ventricular performance [16]. Other studies documented an improvement of left ventricular systolic performance in clinical and experimental models of heart failure after benfotiamine administration, whereas the drug had no effect in healthy hearts [16,17]. Benfotiamine, a transketolase activator, directing glucose to the pentose phosphate pathway, improves experimentally, the functional recovery of infarcted murine hearts, by activation of pro-survival G6PD/Akt signalling pathway and modulation of neurohormonal response [18].…”

The Beriberi Heart

“…Thiamin deficiency appears to be common in patients with heart failure, and supplementation has been shown to improve cardiac function, urinary output, weight loss and signs and symptoms. Therefore, this simple therapy should be tested in large scale randomized clinical trials to further determine the effects of thiamin in heart failure patients (25).…”

“…A systematic review of the literature found 20 articles, revealing evidence that supplementing heart failure with thiamine has the potential to improve left ventricular ejection fraction. Thiamin deficiency appears to be not uncommon in patients with heart failure (25) …”