Exercise in Patients With Bicuspid Aortic Valve and Aortic Dilation

Vigorous exercise is discouraged among individuals with aortic dilation (≥4.0 cm) or aneurysm (≥4.5 cm). Although bicuspid aortic valve (BAV) is associated with aortic dilation, the absolute incidence of acute aortic syndrome is low (3.1/10,000 patient-years). We examined the association of exercise with aortic growth in BAV patients with aortic dilation.

Data were collected from a prospectively enrolled cohort at Northwestern University including BAV patients with aortic dilation on computed tomography/magnetic resonance imaging and without prior aortic intervention. Patients who engaged in exercise with high dynamic and/or static components for >4 h/wk were classified as higher intensity and duration (I&D) exercisers. Those engaging in activities for <4 h/wk were defined as lower I&D exercisers. Sensitivity testing was also performed using a 2-hour/week threshold.

There were 70 higher I&D and 54 lower I&D exercisers (median follow-up, 8.8 years). Demographics, cardiovascular risk factors, and beta-blocker and statin use were similar between groups. No univariable differences in aortic diameter evolution at the sinus of Valsalva, sinotubular junction, midascending aorta, or proximal aortic arch were observed between exercise groups. There were no instances of acute aortic syndrome.

Higher I&D exercise was not associated with progressive aortic dilation among patients with BAV and aortic dilation. This warrants further study and reexamination of exercise restrictions in patients with BAV and aortic dilation as such restrictions may deter otherwise healthful cardiovascular behaviors.