Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy.
Shimon I; Almog S; Vered Z; Seligmann H; Shefi M; Peleg E; Rosenthal T; Motro M; Halkin H; Ezra D
American Journal of Medicine 1995 May;98(5):485-90
PURPOSE: We have previously found thiamine (vitamin B1) deficiency in
patients with congestive heart failure (CHF) who had received long-term
furosemide therapy. In the present study, we assessed the effect of thiamine
repletion on thiamine status, functional capacity, and left ventricular
ejection fraction (LVEF) in patients with moderate to severe CHF who had
received furosemide in doses of 80 mg/d or more for at least 3 months.
PATIENTS AND METHODS: Thirty patients were randomized to 1 week of double-blind
inpatient therapy with either i.v. thiamine 200 mg/d or placebo (n = 15
each). All previous drugs were continued. Following discharge, all 30
patients received oral thiamine 200 mg/d as outpatients for 6 weeks. Thiamine
status was determined by the erythrocyte thiamine-pyrophosphate effect
(TPPE). LVEF was determined by echocardiography. RESULTS: TPPE, diuresis,
and LVEF were unchanged with i.v. placebo. After i.v. thiamine, TPPE decreased
(11.7% +/- 6.5% to 5.4% +/- 3.2%; P < 0.01). LVEF increased (0.28 +/-
0.11 to 0.32 +/- 0.09; P < 0.05), as did diuresis (1,731 +/- 800 mL/d
to 2,389 +/- 752 mL/d; P < 0.02), and sodium excretion (84 +/- 52 mEq/d
to 116 +/- 83 mEq/d, P < 0.05). In the 27 patients completing the full
7-week intervention, LVEF rose by 22% (0.27 +/- 0.10 to 0.33 +/- 0.11,
P < 0.01). CONCLUSIONS: Thiamine repletion can improve left ventricular
function and biochemical evidence of thiamine deficiency in some patients
with moderate-to-severe CHF who are receiving longterm furosemide therapy.
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