Nutritional deficiency cardiomyopathy: A review and pooled analysis of pathophysiology, diagnosis and clinical management

Abstract

The increasing recognition of deficiency of certain essential micronutrients in the failing heart suggests that they may be involved in the pathogenesis of nutritional deficiency cardiomyopathy (NDCM) and ultimately heart failure (HF). Chronic deficits in thiamine, carnitine, selenium, niacin, taurine and Coenzyme Q10 in the myocardial tissues have already been associated with alterations in myocardial energy production, calcium balance or oxidative defences. These pathologic changes may lead to metabolic or myocardial remodelling progressing into NDCM. Due to the severity of potential outcomes of untreated NDCM, it is important for cardiologists to have a good understanding of NDCM. More importantly, NDCM is a treatable phenotype of dilated or hypertrophic cardiomyopathy (CM). Early detection and prompt initiation of nutrient supplementation therapy (NST) has the potential to reverse pathologic myocardial changes and resolve cardiac symptoms. However, current expert consensus guidelines on the treatment of HF do not expressly recommend or are conspicuously silent about the use of NST possibly attributable to inconsistent findings by several small-scale trials and the lack of reliable data by large-scale randomized clinical trials. This review summarizes the existing published data about NDCM with an emphasis on the specific aetiologic micronutrients deficiencies, including their pathophysiology, manifestation, diagnosis and clinical management. This review also identifies gaps in current studies and areas of limited knowledge to move forward with research to fill these critical gaps in knowledge.