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QUARTERLY FOCUS ISSUE: HEART FAILURE: VIEWPOINT

Micronutrient Deficiencies

An Unmet Need in Heart Failure

Victor Soukoulis, MD, PhD^_*, Jamil B. Dihu, DO, Michael Sole, MD, Stefan D. Anker, MD, PhD^||,¶, John Cleland, MD^#, Gregg C. Fonarow, MD^_**, Marco Metra, MD, Evasio Pasini, MD, Theresa Strzelczyk, APN, CNS^_*, Heinrich Taegtmeyer, MD, DPhil^,_* and Mihai Gheorghiade, MD

^_* Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Center for Cardiovascular Quality and Outcomes, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Department of Medicine, University of Chicago (North Shore), Pritzker School of Medicine, Chicago, Illinois
Division of Cardiology, University Health Network, Toronto, Ontario, Canada
^|| Department of Cardiology, Charite, Campus Virchow-Klinikum, Berlin, Germany
^¶ Centre for Clinical and Basic Research, IRCCS San Raffaele, Roma, Italy
^# Department of Cardiology, Castle Hill Hospital, Hull York Medical School, Kingston upon Hull, United Kingdom
^_** Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
Section of Cardiovascular Diseases, Department of Experimental and Applied Sciences, University of Brescia, Brescia, Italy
Fondazione "S Maugeri," Medical Centre of Lumezzane, Brescia, Italy
Department of Medicine/Cardiology, University of Texas Houston Medical School, Houston, Texas

Manuscript received July 16, 2009; revised manuscript received August 24, 2009, accepted August 25, 2009.

^_* Reprint requests and correspondence: Dr. Heinrich Taegtmeyer, Department of Internal Medicine, Division of Cardiology, University of Texas Houston Medical School, 6431 Fannin, MSB 1.246, Houston, Texas 77030 (Email: Heinrich.Taegtmeyer{at}uth.tmc.edu).

Heart failure (HF) is a common, disabling, and costly disease. Despite major advances in medical therapy, morbidity and mortality remain high, in part because current pharmacological regimens may not fully address some unique requirements of the heart for energy. The heart requires a continuous supply of energy-providing substrates and amino acids in order to maintain its function. In HF, defects in substrate metabolism and cardiac energy and substrate utilization may contribute to contractile dysfunction. HF is often accompanied by a deficiency in key micronutrients required for unimpeded energy transfer. Correcting these deficits has been proposed as a method to limit or even reverse the progressive myocyte dysfunction and/or necrosis in HF. This review summarizes the existing HF literature with respect to supplementation trials of key micronutrients involved in cardiac metabolism: coenzyme Q10, L-carnitine, thiamine, and amino acids, including taurine. Studies using a broader approach to supplementation are also considered. Although some of the results are promising, none are conclusive. There is a need for a prospective trial to examine the effects of micronutrient supplementation on morbidity and mortality in patients with HF.

Key Words: heart failure • nutrition • energy • micronutrients • metabolism

Abbreviations and Acronyms   ATP = adenosine triphosphate   CoQ10 = coenzyme Q10   EF = ejection fraction   HF = heart failure   LV = left ventricle/ventricular   LVEDV = left ventricular end-diastolic volume   LVESV = left ventricular end-systolic volume   MRI = magnetic resonance imaging   NYHA = New York Heart Association

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J. Am. Coll. Cardiol. 2009 54: A26. [Full Text] [PDF]