Burden of Heart Failure in Patients With Tricuspid Regurgitation and Effect of Transcatheter Repair on Different Subdimensions of Quality of Life

Abstract

Background: Right-sided heart failure (HF) due to severe tricuspid regurgitation (TR) is associated with reduced quality of life (QoL). Here, we analyzed the impact of TR on specific QoL dimensions and the effect of transcatheter tricuspid valve intervention (TTVI) on individual QoL items.

Methods and results: In this study, we included 174 patients with HF (49% women; median age, 79 years; 97% New York Heart Association ≥3) with baseline QoL assessment undergoing TTVI by transcatheter edge-to-edge-repair at our center between April 2016 and March 2022. QoL was assessed by the standardized Minnesota Living With HF Questionnaire. QoL change after TTVI and correlation to functional end points were analyzed. In addition, all QoL domains and the 21 individual items of the Minnesota Living With HF Questionnaire were analyzed. TTVI significantly reduced TR (TR ≥3: baseline 95%, 1-year-follow-up 7%; P<0.001). Total Minnesota Living with HF Questionnaire score improved from 37 (interquartile range, 26-50) points to 31 (interquartile range, 17-42) points (median follow-up-interval, 355 days; P<0.001). QoL improvement was associated with positive New York Heart Association class, 6-minute walking distance, and actigraphy changes (all P<0.05). The detailed analysis revealed that all items of the physical-related QoL dimension were impaired at baseline and strongly improved after TTVI. In contrast, the emotional and "social" Minnesota Living With HF Questionnaire dimensions were largely unaffected at baseline, yet specific items improved with TTVI.

Conclusions: In this single-center study, we delineate the QoL-associated disease burden of TR and identify specific QoL items that improved after TTVI. Our findings support TTVI in patients with reduced QoL and may add to the development of specific tools assessing the functional status of an increasing patient population undergoing TTVI.

Keywords: functional status; quality of life; right‐sided heart failure; transcatheter tricuspid edge‐to‐edge repair; transcatheter tricuspid valve intervention; tricuspid regurgitation.

Figure 1. Improvement of TR after TTVI.

Echocardiographic grading of TR in 174 patients with right‐sided heart failure with underlying and clinically leading TR before TTVI (left column). Grading of TR was repeated after the procedure at the day of discharge from the hospital (middle column) and at 1‐y follow‐up (right column). TR indicates tricuspid regurgitation; and TTVI, transcatheter tricuspid valve intervention.

Figure 2. Change of overall QoL after TTVI.

A, Change of the total MLHFQ score between the baseline (BL) assessment before transcatheter tricuspid valve intervention (TTVI; left pink column) and the 1‐y follow‐up visit after TTVI (right blue column). B, Improvement of QoL after TTVI by BL QoL level (minimal BL impairment: patients below quartile 1 in the BL MLHFQ score; moderate BL impairment: patients within the interquartile range (IQR) in the BL MLHFQ score; severe BL impairment: patients above quartile 3 in the BL MLHFQ score). The middle horizontal lines represent the median, the box shows the IQR, and error bars show the range of nonoutlying data points (whiskers). The lower whisker shows the lowest data point within the 25th percentile minus 1.5 times IQR and the upper whisker shows the highest data point within the 75th percentile plus 1.5 times IQR. MLHFQ indicates Minnesota Living With Heart Failure Questionnaire; and QoL, quality of life.

Figure 3. Change of QoL according to the magnitude of TR reduction.

The change of the total MLHFQ score was calculated according to the reduction of TR between the baseline assessment and the long‐term 1‐y follow‐up visit after transcatheter tricuspid valve intervention. QoL change was expressed as median change of the MLHFQ score for each group. MLHFQ indicates Minnesota Living With Heart Failure Questionnaire; QoL, quality of life; and TR, tricuspid regurgitation.

Figure 4. Change of QoL in association to functional end points after TTVI.

The change of NYHA functional class (left), distance of 6MWDT, and the mean steps per day assessed by activity tracking devices to the wrist for 1 wk (right) before TTVI and 1 year after TTVI was analyzed. Patients were stratified in groups with worsened or unchanged (left column of each subfigure) and improved functional end point (right column of each subfigure). QoL change was expressed as median change of the total MLHFQ score for each group. 6‐MWDT indicates 6‐minute walking distance test; MLHFQ, Minnesota Living With Heart Failure Questionnaire; NYHA, New York Heart Association; QoL, quality of life; and TTVI, transcatheter tricuspid valve intervention.

Figure 5. Change of the physical dimension in QoL after TTVI.

The individual items of the physical subdomain of the MLHFQ were assessed before TTVI (pink columns) and 1 y after TTVI (blue columns). The median score for each QoL item with acquisition at both time points (n=160–173) was calculated. The middle vertical lines represent the median, the box shows the interquartile range (IQR), and error bars show the range of nonoutlying data points (whiskers). The left whisker shows the lowest data point within the 25th percentile minus 1.5 times IQR and the right whisker shows the highest data point within the 75th percentile plus 1.5 times IQR. MLHFQ indicates Minnesota Living With Heart Failure Questionnaire; Q, question; QoL, quality of life; and TTVI, transcatheter tricuspid valve intervention.

Figure 6. Change of the emotional dimension in QoL after TTVI.

The individual items of the emotional sub‐domain of the MLHFQ were assessed before TTVI (pink columns) and 1 y after TTVI (blue columns). The median score for each QoL item with acquisition at both time points (n=163–170) was calculated. The middle vertical lines represent the median, the box shows the interquartile range (IQR), and error bars show the range of nonoutlying data points (whiskers). The left whisker shows the lowest data point within the 25th percentile minus 1.5 times IQR, and the right whisker shows the highest data point within the 75th percentile plus 1.5 times IQR. MLHFQ indicates Minnesota Living With Heart Failure Questionnaire; Q, question; QoL, quality of life; and TTVI, transcatheter tricuspid valve intervention.

Figure 7. Change of the social dimension in QoL after TTVI.

The individual nonphysical/nonemotional items of the MLHFQ describing a social dimension of QoL were assessed before TTVI (pink columns) and 1 y after TTVI (blue columns). The median score for each QoL item with acquisition at both time points (n=123–169) was calculated. The middle vertical lines represent the median, the box shows the interquartile range (IQR), and error bars show the range of nonoutlying data points (whiskers). The left whisker shows the lowest data point within the 25th percentile minus 1.5 times IQR and the right whisker shows the highest data point within the 75th percentile plus 1.5 times IQR. MLHFQ indicates Minnesota Living With Heart Failure Questionnaire; Q, question; QoL, quality of life; and TTVI, transcatheter tricuspid valve intervention.