title: Thiamine deficiency and cardiac dysfunction in Cambodian infants.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mayo Medical School, College of Medicine, Rochester, MN. Electronic address: porter.samuel@mayo.edu.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Porter
authors.affiliation: Eastern Mennonite Missions, Prey Veng, Cambodia.
authors.forename: Debra
authors.initials: D
authors.lastname: Coats
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Fischer
authors.affiliation: National Maternal and Child Health Center, University of Health Science, Phnom Penh, Cambodia.
authors.forename: Kevanna
authors.initials: K
authors.lastname: Ou
authors.affiliation: Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Frank
authors.affiliation: Department of Family Medicine, International University, Phnom Penh, Cambodia.
authors.forename: Phivan
authors.initials: P
authors.lastname: Sreang
authors.affiliation: Department of Family Medicine, International University, Phnom Penh, Cambodia.
authors.forename: Soksan
authors.initials: S
authors.lastname: Saing
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Enders
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data; D001602:Beriberi / Q000097:blood / Q000150:complications / Q000208:ethnology; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013832:Thiamine Deficiency / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D013835:Thiamine Pyrophosphate / Q000097:blood / Q000627:therapeutic use*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D013835:Thiamine Pyrophosphate