In patients with congestive heart failure, thiamine deficiency has been demonstrated by the test-dose method (1, 2), by measurement of the lactate-pyruvate ratio of the blood (3), and by determination of blood cocarboxylase (4). The oxidation of pyruvate to acetate requires thiamine in the form of cocarboxylase (thiamine pyrophosphate). Olson, Pearson, Miller, and Stare have shown that thiamine deficiency in experimental animals (rats and ducks) resulted in a decrease in the ability of cardiac muscle slices to oxidize pyruvate (5). The present investigation was thus undertaken to determine the thiamine and cocarboxylase content of cardiac muscle in patients with heart failure as compared with that of non-cardiac patients. To our knowledge no data are available on this point in the literature.
METHODSPatients were selected from the Philadelphia General Hospital and Temple University Hospital under treatment for congestive heart failure. In order to study the influence of long-standing heart disease upon the thiamine and cocarboxylase content of heart muscle only those patients who had failed to respond to therapy and expired with manifestations of cardiac decompensation were analyzed. There were twelve cases from whom tissues were obtained at post-mortem examination including seven with hypertensive cardiovascular disease, four with arteriosclerotic heart disease, and one with rheumatic heart disease. There were six males, and six females; their ages ranged from 39 to 81 years. The duration of treatment for heart disease in eight patients ranged from two and one-half years to eight years in the cardiac clinics or by private physicians; in four patients the duration of the disease could not be accurately determined. In each instance, treatment included the use of digitalis, mercurial diuretics or ammonium chloride, and salt restriction diets. Despite these regimens, symptoms of dyspnea, orthopnea due to pulmonary congestion, dependent edema, venous hypertension, hepatomegaly, ascites and hydrothorax (two cases) persisted, necessitating hospitalization. The patients reteived no supplementary vitamins but were treated with diuretic agents, digitalis, oxygen, bed rest, and restricted sodium intake. The patients expired with manifestations of advanced heart failure including Cheyne-Stokes respiration, pulmonary congestion, and general signs of anoxia. The