Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy.
OBJECTIVE
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.


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.
Shimon
I
I
Division of Clinical Pharmacology, Sheba Medical Center, Tel-Hashomer, Israel.
Almog
S
S
Vered
Z
Z
Seligmann
H
H
Shefi
M
M
Peleg
E
E
Rosenthal
T
T
Motro
M
M
Halkin
H
H
Ezra
D
D
D000368:Aged; D000369:Aged, 80 and over; D004231:Diuresis / Q000187:drug effects; D004311:Double-Blind Method; D004452:Echocardiography; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D005665:Furosemide / Q000009:adverse effects* / Q000627:therapeutic use; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D013831:Thiamine / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D013835:Thiamine Pyrophosphate / Q000378:metabolism; D016277:Ventricular Function, Left / Q000187:drug effects*
D005665:Furosemide; D013835:Thiamine Pyrophosphate; D013831:Thiamine