Background

Tricuspid regurgitation is known to be associated with impaired cognitive function in addition to quality of life and exercise capacity decline. Transcatheter tricuspid valve interventions (TTVR) are addressing the urgent need for novel treatment options of tricuspid regurgitation particularly in patients with high surgical risk, and showing promising results so far. Therefore, this study examined the impact of TTVR on cognitive function, quality of life and exercise capacity.

Methods

Cognitive function assessment (executive, naming, memory, attention, language, abstraction, orientation) was performed with standardized Montreal Cognitive Assessment test (MoCA) in 37 patients with at least severe tricuspid regurgitation and symptomatic heart failure (NYHA ≥ II) before and 3 months after transcatheter tricuspid valve intervention alongside with echocardiographic controls and assessment of exercise capacity and quality of life.

Results

Mean patient age was 79.3 ± 5.4 years and 51.4% were female. Technical success could be achieved in all cases. 9 patients showed a reduction of tricuspid regurgitation less than 2 grades (tricuspid regurgitation ≥ 3 at follow up 13.5%; p<0.001). Overall cognitive function improved significantly (from 20.0 ± 4.5 to 22.3 ± 4.2) with particularly significant improvements in the subcategories executive function (p=0.001), naming (p=0.005) and abstraction (p<0.001).

The walked distance (from 283.9 ± 92.5 m to 316.7 ± 93,8 m, p=0.002) and quality of life (MLHFQ-Score from 30.8 ± 16.8 to 22.5 ± 12.6, p=0.005) showed also significant improvements 3 months after TTVR transcatheter intervention for tricuspid regurgitation.

Discussion

Our study shows significant improvement in cognitive function, exercise capacity and quality of life. Since heart failure and severe tricuspid regurgitation are associated with impaired cardiac output and a reverse venous flow/pressure, TTVR that has been shown to increase hemodynamic performance may lead to an improved cerebral perfusion which could explain our improvements in cognitive function. Eventually, the improved heart failure symptoms, exercise capacity and cognitive function are reflected in the correspondingly improved quality of life.

Conclusion

Cognitive function can be significantly improved in patients with tricuspid regurgitation undergoing transcatheter tricuspid valve intervention.