Thiamine responsive high output heart failure of adults: an under-recognized entity

• Published in: European journal of clinical nutrition Vol. 77; no. 7; pp. 757 - 760
• Main Authors: Nisar, Sobia, Mohi-u-din, Khalid, Tak, Shahid Iqbal, Andrabi, Syed Manzoor Ali, Tanvir, Masood, Muzaffer, Umar, Kareem, Ozaifa, Ganie, Mohd. Ashraf
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2023; Nature Publishing Group
• Subjects: 101/47; 692/308/2778; 692/700/2814; 82/16; Adult; Adults; Aged; Beriberi - diagnosis; Beriberi - drug therapy; Brief Communication; Cardiovascular diseases; Clinical Nutrition; Congestive heart failure; Diuretics; Epidemiology; Heart diseases; Heart failure; Heart Failure - drug therapy; Humans; Internal Medicine; Intravenous administration; Lactic acid; Medicine; Medicine & Public Health; Metabolic Diseases; Oxygen; Oxygen content; Oxygen saturation; Public Health; Thiamine; Thiamine - therapeutic use; Thiamine Deficiency - drug therapy; Thiamine Pyrophosphate - therapeutic use; Vitamin B; Vitamin deficiency
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/s41430-023-01279-7

Thiamine deficiency, commonly presenting as dry and wet beriberi, a lesser-known entity in the present era, is increasingly being reported from Kashmir, a north Indian state. The present study aims to present the clinical profile of patients presenting with high-output heart failure (HOHF). Subjects with a primary diagnosis of denovo heart failure and features suggestive of HOHF were recruited; those who responded to intravenous administration of thiamine alone (responders) were adults with no co-morbidities and those who required other medications particularly diuretics (non-responders) were elderly with co-morbidities and underlying heart disease. Responders showed considerably lower mean thiamine pyrophosphate (TPP) levels and higher mean lactate and venous oxygen saturation than non-responders. More importantly, the mean drop in lactate and SVO2 following thiamine therapy was more in responders. In a setting of high risk for thiamine deficiency, features suggestive of HOHF along with elevated lactate and higher venous oxygen saturation, a response to thiamine challenge may serve as surrogate marker of thiamine deficiency.