To the Editor: Heart failure is a major cause of morbidity and mortality in the world and is the leading cause of hospitalization in older patients. 1 There is a growing interest in the role of metabolic abnormalities in myocardial damage and dysfunction. 2 Thiamine pyrophosphate (TPP) serves as coenzyme for the oxidative decarboxylation in the mitochondria. It accounts for more than 80% of total erythrocyte thiamine and alone is taken as the best expression of thiamine nutritional status. 3 The incidence of thiamine deficiency in patients with heart failure ranges from 13% to 93%. 2 Most studies concerning that issue have been conducted in developed countries, with sparse data from developing countries. The current study aimed to determine thiamine status in elderly Egyptian patients with congestive heart failure (CHF) with left ventricular systolic dysfunction (LVSD).
METHODSA case control study was conducted of 126 individuals aged 60 and older recruited from geriatric, cardiology, and internal medicine departments and a geriatrics outpatient clinic at Ain Shams University hospital, subdivided into two groups matched for age, sex and nutritional risk: cases group (63 individuals with CHF diagnosed according to the Framingham criteria with left ventricular ejection fraction (LVEF) less than 50%) and control group (63 individuals). Subjects taking vitamins or other drugs, having diseases affecting thiamine level, or unable to give informed consent were excluded. Demographic data, medical history, mininutritional assessment, and assessment of liver and kidney functions and fasting blood sugar were evaluated for all participants. TPP (normal range 32-95 ng/mL) was determined using high-performance liquid chromatography (Vitamin B1 HPLC Kit, Immunodiagnostic, Bensheim, Germany).
RESULTSSixty-three patients with CHF with LVEF less than 50% were recruited between June 2006 and June 2007. Mean age was 67.0 AE 4.6; 40 (63.5%) were male and 23 (36.5%) female. None had diabetes mellitus. All were receiving furosemide diuretic therapy. Twenty-eight were New York Heart Association (NYHA) Class II, 26 were Class III, and nine were Class IV; 22 had a LVEF of 35% to 49%, 28 of 25% to 34%, and 13 of less than 25%. There was no difference in nutritional status between cases and controls, with 32 of cases having good nutrition, 22 probably being malnourished, and nine having bad nutrition, versus 34 of controls with good nutrition, 25 probably malnourished, and four with bad nutrition (P 5.69).
Thiamine StatusSeventeen cases with CHF were found to be thiamine deficient, compared with nine in the control group, but this was not statistically significant (P 5.08). TPP level was significantly lower in cases (45.1 ng/mL (range 16.0-79.5 ng/mL) than controls (52.6 ng/mL (range 20.1-90.
