Role of Thiamine Deficiency and Efficacy of Thiamine in Treatment of Patients With Heart Failure.

Abstract

Thiamine is a water soluble B-complex vitamin readily available in cereal grains, yeast, nuts and meat products. It combines with adenosine triphosphate in liver, kidneys and leukocyte to form thiamine pyrophosphate, a coenzyme in carbohydrate metabolism 1 .Diagnosis of thiamine deficiency is frequently obtained by measuring thiamine pyrophosphate effect (TPPE). TPPE reflects thiamine concentrations on the basis of activity of thiamine diphosphate on the transketolase enzyme of pentose shunt 2 .A thiamine pyrophosphate effect of 0 to 15% is considered normal, 15% to 24% indicative of marginal deficiency, and >25% associated with several deficiency 3 .Thiamine status can be assessed also by direct measurement of thiamine pyrophosphate in erythrocytes or whole blood by high performance liquid chromatography (HPLC). This method is precise and yields results similar to erythrocyte activation assay 4 .Specific signs and symptoms observed in thiamine-deficient patients represent alterations in the biochemistry of thiamine that result in impaired oxidative phosphorylation, increased levels of proximal metabolites (pyruvate), and decreased transketolase activity in RBCs, liver, heart and other organs. Thiamine deficiency manifests as dry or wet beri beri. Dry beri beri involves peripheral neuropathy that can be permanent even following thiamine repletion. Neurological side effects of thiamine deficiency can progress to Wernicke-koraskoff syndrome 5 .Heart failure (HF) is a common, disabling and costly disease throughout the world. The recommended pharmacological therapy includes the use of angiotensin converting enzyme inhibitors, angiotensin receptor