Impact of tricuspid regurgitation on activities of daily life and dementia in patients with heart failure -insight from the KUNIUMI registry chronic cohort-

Abstract Background Significant tricuspid regurgitation (TR) is widely recognized as an independent risk factor for poor prognosis and an adverse clinical course in patients with various types of heart failure (HF). Thus, TR is no longer considered a negligible disease, especially current aging society. Meanwhile, activities of daily life (ADL) including dementia is also age-related and highly prevalent worldwide, and is known to be a risk factor for HF. However, the association of the presence of TR with ADL and dementia in HF patients remains uncertain. Purpose To investigate the impact of TR on ADL and Dementia in HF patients. Methods A total of 1,646 consecutive HF patients were prospectively enrolled between March 2019 and March 2021 from the KUNIUMI registry chronic cohort in this study. Mean age was 76.0 ± 11.1 years, 1,084 patients (65.9%) were male. TR was quantified by measuring vena contracta width of TR by means of transthoracic echocardiography. The severity of TR was graded as less than mild (vena contracta width 0.3 cm), moderate (vena contracta width: 0.3-0.69 cm), or severe (vena contracta width ≥ 0.7 cm) based on the current guidelines. ADL was defined as Barthel Index, and dementia was defined as the ABC Dementia Scale (ABC-DS). Both Barthel Index and ABC-DS were evaluated baseline and 1-year follow-up. Results Among enrolled 1,646 HF patients, 1,269 HF patients were available for quantifying TR severity. 125 HF patients were classified as severe TR, 139 HF patients were classified as moderate TR, and remaining 1,005 HF patients were classified as less than mild TR. Barthel Index and ABC-DS between baseline and 1-year follow-up were similar in HF patients with less than mild TR and those with moderate TR (HF patients with less than mild TR: Barthel Index: 94.9 vs. 94.9, P=0.75 and ABC-DS: 113.3 vs. 113.6, P=0.42, HF patients with moderate TR: Barthel Index: 88.6 vs. 86.9, P=0.31 and ABC-DS: 109.9 vs. 108.3, P=0.16). However, Barthel Index and ABC-DS significantly decreased from 88.5 to 82.0 (p0.001) and from 108.8 to 103.6 (p0.001) between baseline and 1-year follow-up in HF patients with severe TR. In addition, multivariate analysis revealed that age and the presence of severe TR were independently associated with a decrease in both Barthel Index and ABC-DC. Conclusions The presence of severe TR was strongly associated with ADL and dementia in HF patients. Our findings can provide new insights of the importance of management of HF patients with severe TR in terms of the progression of ADL and dementia in the era of super-aged society.