Thiamine deficiency and cardiac dysfunction in Cambodian infants.

Abstract

OBJECTIVES:

To compare blood thiamine concentrations, echocardiography findings, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in infants with clinically diagnosed beriberi and healthy matched controls, and to evaluate changes after thiamine treatment.

STUDY DESIGN:

Sixty-two Cambodian infants (20 cases and 42 controls), aged 2-47 weeks, were enrolled in this prospective study. Echocardiography and phlebotomy were performed at baseline and after thiamine treatment.

RESULTS:

Both cases and controls were thiamine-deficient, with median blood thiamine diphosphate (TDP) concentrations of 47.6 and 55.1 nmol/L, respectively (P = .23). All subjects had normal left ventricular ejection fraction. The median NT-proBNP concentration in cases (340 pg/mL [40.1 pmol/L]) was higher than previously reported normal ranges, but not statistically significantly different from that in controls (175 pg/mL [20.7 pmol/L]) (P = .10), and was not correlated with TDP concentration (P = .13). Two cases with the lowest baseline TDP concentrations (24 and 21 nmol/L) had right ventricular enlargement and elevated NT-proBNP levels that improved dramatically by 48 hours after thiamine administration.

CONCLUSION:

Only a minority of thiamine-deficient Cambodian infants demonstrate abnormal echocardiography findings. Thiamine deficiency produces echocardiographic evidence of right ventricular dysfunction, but this evidence is not apparent until deficiency is severe. NT-proBNP concentrations are mildly elevated in sick infants with normal echocardiography findings, indicating possible physiological changes not yet associated with echocardiographic abnormalities.

• Authors: Samuel G Porter, Debra Coats, Philip R Fischer, Kevanna Ou, Elizabeth L Frank, Phivan Sreang, Soksan Saing, Mark D Topazian, Felicity T Enders, Allison K Cabalka
• Journal: The Journal of pediatrics (J Pediatr) Vol. 164 Issue 6 Pg. 1456-61 (Jun 2014) ISSN: 1097-6833 [Electronic] United States
• PMID: 24607240 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Thiamine Pyrophosphate

Topics

• Asian People (statistics & numerical data)
• Beriberi (blood, complications, ethnology)
• Biomarkers (metabolism)
• Case-Control Studies
• Echocardiography, Doppler (methods)
• Female
• Follow-Up Studies
• Heart Function Tests
• Humans
• Infant
• Infant, Newborn
• Male
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Reference Values
• Risk Assessment
• Severity of Illness Index
• Thiamine Deficiency (blood, complications, drug therapy, ethnology)
• Thiamine Pyrophosphate (blood, therapeutic use)
• Treatment Outcome
• Ventricular Dysfunction, Left (diagnosis, ethnology, etiology)