Skip to main content

Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study



Diuretic treatment for heart failure may lead to an increased urinary thiamine excretion and in long-term thiamine deficiency, which may further compromise cardiac function. This study evaluated the effect of high dose thiamine supplementation in heart failure patients.


Nine patients with diuretic treatment for symptomatic chronic heart failure and a left ventricular ejection fraction (LVEF) <40% were randomly assigned to receive thiamine (300 mg/day) or placebo for 28 days. After a wash-out of 6 weeks, the patients crossed-over to a second treatment period. The primary outcome was a change in LVEF.


Mean age was 56.7 ± 9.2 years (range 44.9–75.4 years). Baseline LVEF was similar for both treatment groups (29.5% in the thiamine group and 29.5% in the placebo group, P = 0.911). After 28 days of thiamine treatment, the LVEF increased to 32.8% which was significantly (P = 0.024) different from the LVEF in the placebo group (28.8%). This corresponds to a treatment effect for LVEF of 3.9% in absolute terms.


This study suggests that thiamine supplementation has beneficial effects on cardiac function in patients with diuretic drugs for symptomatic chronic heart failure. Subclinical thiamine deficiency is probably an underestimated issue in these outpatients.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. van-Kraaij DJ, Jansen RW, de-Gier JJ, Gribnai FW, Hoefnagels WH (1998) Prescription patterns of diuretics in Dutch community-dwelling elderly patients. Br J Clin Pharmacol 46:403–407

    PubMed  Article  CAS  Google Scholar 

  2. Yui Y, Itokawa Y, Kawai C (1980) Furosemide-induced thiamine deficiency. Cardiovasc Res 14:537–540

    PubMed  Article  CAS  Google Scholar 

  3. Rieck J, Halkin H, Almog S, Seligman H, Lubetsky A, Olchovsky D, Ezra D (1999) Urinary loss of thiamine is increased by low doses of furosemide in healthy volunteers. J Lab Clin Med 134:238–243

    PubMed  Article  CAS  Google Scholar 

  4. Suter PM, Vetter W (2000) Diuretics and vitamin B1: are diuretics a risk factor for thiamin malnutrition? Nutr Rev 58:319–323

    PubMed  Article  CAS  Google Scholar 

  5. Suter PM, Haller J, Hany A, Vetter W (2000) Diuretic use: a risk factor for subclinical thiamine deficiency in elderly patients. J Nutr Health Aging 4:69–71

    PubMed  CAS  Google Scholar 

  6. Hanninen SA, Darling PB, Sole MJ, Barr A, Keith ME (2006) The prevalence of thiamin deficiency in hospitalized patients with congestive heart failure. J Am Coll Cardiol 47:354–361

    PubMed  Article  CAS  Google Scholar 

  7. Katare RG, Caporali A, Oikawa A, Meloni M, Emanueli C, Madeddu P (2010) Vitamin B1 analog benfotiamine prevents diabetes-induced diastolic dysfunction and heart failure through Akt/Pim-1-mediated survival pathway. Circ Heart Fail 3:294–305

    PubMed  Article  CAS  Google Scholar 

  8. Gioda CR, Roman-Campos D, Carneiro-Júnior MA, da Silva KA, de Souza MO, Mendes LJ, Natali AJ, Cruz JS (2009) Impaired cellular contractile function in thiamine-deficient rat cardiomyocytes. Eur J Heart Fail 11:1126–1128

    PubMed  Article  Google Scholar 

  9. Abelmann WH, Lorell BH (1989) The challenge of cardiomyopathy. J Am Coll Cardiol 13:1219–1239

    PubMed  Article  CAS  Google Scholar 

  10. Seligmann H, Halkin H, Rauchfleisch S, Kaufmann N, Motro M, Vered Z, Ezra D (1991) Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: a pilot study. Am J Med 91:151–155

    PubMed  Article  CAS  Google Scholar 

  11. Shimon I, Almog S, Vered Z, Seligmann H, Shefi M, Peleg E, Rosenthal T, Motro M, Halkin H, Ezra D (1995) Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy. Am J Med 98:485–490

    PubMed  Article  CAS  Google Scholar 

  12. Pfitzenmeyer P, Guilland JC, d’Athis P, Petit-Mernier C, Gaudet M (1994) Thiamine status of elderly patients with cardiac failure including the effects of supplementation. Int J Vitam Nutr Res 64:113–118

    PubMed  CAS  Google Scholar 

  13. Witte KK, Nikitin NP, Parker AC, von Haehling S, Volk HD, Anker SD, Clark AL, Cleland JG (2005) The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure. Eur Heart J 26:2238–2244

    PubMed  Article  CAS  Google Scholar 

  14. Luers C, Wachter R, Kleta S, Uhlir M, Koschack J, Scherer M, Binder L, Herrmann-Lingen C, Zapf A, Kulle B, Kochen MM, Pieske B (2010) Natriuretic peptides in the detection of preclinical diastolic or systolic dysfunction. Clin Res Cardiol 99:217–226

    PubMed  Article  CAS  Google Scholar 

  15. Schoenenberger AW, Kobza R, Jamshidi P, Zuber M, Abbate A, Stuck AE, Pfisterer M, Erne P (2009) Sudden cardiac death in patients with silent myocardial ischemia after myocardial infarction (from the Swiss Interventional Study on Silent Ischemia Type II [SWISSI II]). Am J Cardiol 104:158–163

    PubMed  Article  Google Scholar 

  16. Saguner AM, Dür S, Perrig M, Schiemann U, Stuck AE, Bürgi U, Erne P, Schoenenberger AW (2010) Risk factors promoting hypertensive crises: evidence from a longitudinal study. Am J Hypertens 23:775–780

    PubMed  Article  Google Scholar 

  17. Gorelik O, Almoznino-Sarafian D, Shteinshnaider M, Alon I, Tzur I, Sokolsky I, Efrati S, Babakin Z, Modai D, Cohen N (2009) Clinical variables affecting survival in patients with decompensated diastolic versus systolic heart failure. Clin Res Cardiol 98:224–232

    PubMed  Article  Google Scholar 

  18. Karapolat H, Demir E, Bozkaya YT, Eyigor S, Nalbantgil S, Durmaz B, Zoghi M (2009) Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters. Clin Res Cardiol 98:635–642

    PubMed  Article  Google Scholar 

  19. Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Eberli FR, Stuck AE, Gutzwiller F, Erne P, Acute Myocardial Infarction in Switzerland Plus Investigators (2008) Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: a cohort study. J Am Geriatr Soc 56:510–516

    PubMed  Article  Google Scholar 

  20. Kamp O, Metra M, de Keulenaer GW, Pieske B, Conraads V, Zamorano J, Huysse L, Vardas PE, Böhm M, Dei Cas L (2010) Effect of the long-term administration of nebivolol on clinical symptoms, exercise capacity and left ventricular function in patients with heart failure and preserved left ventricular ejection fraction: background, aims and design of the ELANDD study. Clin Res Cardiol 99:75–82

    PubMed  Article  CAS  Google Scholar 

  21. Conen D, Chae CU, Guralnik JM, Glynn RJ (2010) Influence of blood pressure and blood pressure change on the risk of congestive heart failure in the elderly. Swiss Med Wkly 140:202–208

    PubMed  Google Scholar 

  22. Muzzarelli S, Tobler D, Leibundgut G, Schindler R, Buser P, Pfisterer ME, Brunner-La Rocca HP (2009) Detection of intake of nonsteroidal anti-inflammatory drugs in elderly patients with heart failure. How to ask the patient? Swiss Med Wkly 139:481–485

    PubMed  CAS  Google Scholar 

Download references


Andreas Schoenenberger was supported by a Forschungskolleg Geriatrie Grant from the Robert Bosch Foundation, Stuttgart, Germany.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Paul Erne.

Additional information

A. W. Schoenenberger and R. Schoenenberger-Berzins are equally contributed to the manuscript.

Clinical Trial Registration The study is registered at (NCT 00770107).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 90 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Schoenenberger, A.W., Schoenenberger-Berzins, R., der Maur, C.A. et al. Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study. Clin Res Cardiol 101, 159–164 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Thiamine
  • Heart failure
  • Diuretics
  • Cross-over studies