Thiamine Deficiency and Cardiac Dysfunction in Cambodian Infants

• Published in: The Journal of pediatrics Vol. 164; no. 6; pp. 1456 - 1461
• Main Authors: Porter, Samuel G., Coats, Debra, Fischer, Philip R., Ou, Kevanna, Frank, Elizabeth L., Sreang, Phivan, Saing, Soksan, Topazian, Mark D., Enders, Felicity T., Cabalka, Allison K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2014
• Subjects: Asian Continental Ancestry Group - statistics & numerical data; Beriberi - blood; Beriberi - complications; Beriberi - ethnology; Biomarkers - metabolism; Case-Control Studies; Echocardiography, Doppler - methods; Female; Follow-Up Studies; Heart Function Tests; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain - blood; Pediatrics; Peptide Fragments - blood; Reference Values; Risk Assessment; Severity of Illness Index; Thiamine Deficiency - blood; Thiamine Deficiency - complications; Thiamine Deficiency - drug therapy; Thiamine Deficiency - ethnology; Thiamine Pyrophosphate - blood; Thiamine Pyrophosphate - therapeutic use; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - ethnology; Ventricular Dysfunction, Left - etiology; LVEF; TDP; LV; NT-proBNP; RV; ETK; Thiamine diphosphate; Left ventricular ejection fraction; Erythrocyte transketolase; Left ventricular; Right ventricular; N-terminal pro-B type natriuretic peptide
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2014.01.049

To compare blood thiamine concentrations, echocardiography findings, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in infants with clinically diagnosed beriberi and healthy matched controls, and to evaluate changes after thiamine treatment. Sixty-two Cambodian infants (20 cases and 42 controls), aged 2-47 weeks, were enrolled in this prospective study. Echocardiography and phlebotomy were performed at baseline and after thiamine treatment. Both cases and controls were thiamine-deficient, with median blood thiamine diphosphate (TDP) concentrations of 47.6 and 55.1 nmol/L, respectively (P = .23). All subjects had normal left ventricular ejection fraction. The median NT-proBNP concentration in cases (340 pg/mL [40.1 pmol/L]) was higher than previously reported normal ranges, but not statistically significantly different from that in controls (175 pg/mL [20.7 pmol/L]) (P = .10), and was not correlated with TDP concentration (P = .13). Two cases with the lowest baseline TDP concentrations (24 and 21 nmol/L) had right ventricular enlargement and elevated NT-proBNP levels that improved dramatically by 48 hours after thiamine administration. Only a minority of thiamine-deficient Cambodian infants demonstrate abnormal echocardiography findings. Thiamine deficiency produces echocardiographic evidence of right ventricular dysfunction, but this evidence is not apparent until deficiency is severe. NT-proBNP concentrations are mildly elevated in sick infants with normal echocardiography findings, indicating possible physiological changes not yet associated with echocardiographic abnormalities.