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Thiamine responsive high output heart failure of adults: an under-recognized entity

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Abstract

Thiamine deficiency, commonly presenting as dry and wet beriberi, a lesser-known entity in the present era, is increasingly being reported from Kashmir, a north Indian state. The present study aims to present the clinical profile of patients presenting with high-output heart failure (HOHF). Subjects with a primary diagnosis of denovo heart failure and features suggestive of HOHF were recruited; those who responded to intravenous administration of thiamine alone (responders) were adults with no co-morbidities and those who required other medications particularly diuretics (non-responders) were elderly with co-morbidities and underlying heart disease. Responders showed considerably lower mean thiamine pyrophosphate (TPP) levels and higher mean lactate and venous oxygen saturation than non-responders. More importantly, the mean drop in lactate and SVO2 following thiamine therapy was more in responders. In a setting of high risk for thiamine deficiency, features suggestive of HOHF along with elevated lactate and higher venous oxygen saturation, a response to thiamine challenge may serve as surrogate marker of thiamine deficiency.

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Fig. 1: Pre and post-treatment (thiamine challenge) comparison of Ejection fraction, RVSP, SVO2, pH, PO2, PCO2, HCO3, and Lactate among Responders and Non-Responders within 24 h.

Data availability

Applications for data access for non-commercial use can be made to author Sobia Nisar and Mohd. Ashraf Ganie; sobianisar78@gmail.com, ashraf.endo@gmail.com.

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Funding

This study is a part of the ICMR (Nutrition division, Indian Council of Medical Research) funded study entitled “Evaluation of prevalence, risk factors, consequences of thiamine deficiency among apparently healthy community-dwelling Kashmiri population and clinically suspected thiamine deficiency patients attending three major tertiary care hospitals: A cross-sectional study” (ICMR) (5/9/1206/2019-Nut).

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Authors and Affiliations

  1. Department of Medicine, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India

    Sobia Nisar, Masood Tanvir & Umar Muzaffer

  2. Department of Cardiology, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India

    Khalid Mohi-u-din, Shahid Iqbal Tak & Syed Manzoor Ali Andrabi

  3. Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, Jammu and Kashmir, India

    Ozaifa Kareem

  4. Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

    Mohd. Ashraf Ganie

Authors
  1. Sobia Nisar
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  2. Khalid Mohi-u-din
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  3. Shahid Iqbal Tak
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  4. Syed Manzoor Ali Andrabi
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  5. Masood Tanvir
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  6. Umar Muzaffer
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  7. Ozaifa Kareem
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  8. Mohd. Ashraf Ganie
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Contributions

The authors’ responsibilities were as follows—SN, MAG, and MT: designed the research, and guided in writing the manuscript, MAG, SN, UM, OK wrote the paper and analyzed the data and had primary responsibility for the final content, KM, SIT, SMA Andrabi examined the patients from cardiology side and helped in recruitment of the patients, UM has evaluated the blood samples for biochemistry and thiamine levels. All the authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Sobia Nisar or Mohd. Ashraf Ganie.

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The authors declare no competing interests.

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Nisar, S., Mohi-u-din, K., Tak, S.I. et al. Thiamine responsive high output heart failure of adults: an under-recognized entity. Eur J Clin Nutr 77, 757–760 (2023). https://doi.org/10.1038/s41430-023-01279-7

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  • DOI: https://doi.org/10.1038/s41430-023-01279-7

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