IMPROVED LEFT-VENTRICULAR FUNCTION AFTER THIAMINE SUPPLEMENTATION IN PATIENTS WITH CONGESTIVE-HEART-FAILURE RECEIVING LONG-TERM FUROSEMIDE THERAPY

PURPOSE: We have previously found thiamine (vitamin B-1) deficiency in patients with congestive heart failure (CHF) who had received long-te rm 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 seve re 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 IV thiamine 20 0 mg/d or placebo in = 15 each). All previous drugs were continued. Fo llowing discharge, all 30 patients received oral thiamine 200 mg/d as outpatients for 6 weeks. Thiamine status was determined by the erythro cyte thiamine-pyrophosphate effect (TPPE). LVEF was determined by echo cardiography. RESULTS: TPPE, diuresis, and LVEF were unchanged with IV placebo. After IV 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 <0.0 5). In the 27 patients completing the full 7-week intervention, LVEF r ose by 22% (0.27 +/- 0.10 to 0.33 +/- 0.11, P <0.01). CONCLUSIONS: Thi amine repletion can improve left ventricular function and biochemical evidence of thiamine deficiency in some patients with moderate-to-seve re CHF who are receiving longterm furosemide therapy.