10-year Progression of Aortic Dimensions and Valvular Function with Exercise Volume in Patients with a Bicuspid...

Whether exercise can accelerate aortic dilatation and valve dysfunction in patients with a bicuspid aortic valve (BAV) remains uncertain. We assessed the long-term effects of exercise volume on aortic growth and valvular function among BAV patients.

Patients with BAV, aged 30-60 years, with ≥5 years of echocardiographic follow-up were included. Exercise volumes during follow-up were calculated in metabolic equivalent of task minutes per week (MET-min/wk). Aortic growth rates were compared between sedentary (<500 MET-min/wk), active (500-1000 MET-min/wk) and highly active (>1000 MET-min/wk) patients.

We included 118 patients (35±10 years, 57% male) of whom 71 were sedentary, 24 active and 23 highly active. Aortic growth rates were 0.24 mm/year (95%CI, 0.22-0.26) for sinuses of Valsalva (SoV) and 0.40 mm/year (95%CI, 0.37-0.44) for ascending aorta (AA) during 10.8±3.1 years of follow-up. No differences were found in SoV growth rates between sedentary (0.23 mm/year, 95%CI, 0.20-0.26), active (0.24 mm/year, 95%CI, 0.16-0.33, p=0.75) and highly active groups (0.26 mm/year, 95%CI, 0.17-0.35, p=0.38). AA growth rates did not differ between sedentary (0.41 mm/year, 95%CI, 0.37-0.45), active (0.37 mm/year, 95%CI, 0.24-0.50, p=0.42) and highly active groups (0.44 mm/year, 95%CI, 0.30-0.57, p=0.56), even after adjustment for confounders. Incidence of moderate-to-severe aortic stenosis or regurgitation was 5.8% after 5-7 years, and an additional 2.9% for moderate stenosis and 5.9% for moderate regurgitation after 10-12 years, without differences across exercise groups.

Exercise volume did not impact aortic growth rates, indicating that exercise may not play a significant role in the progression of BAV valvulo-aortopathy. These findings suggest that a less restrictive approach towards exercise prescription may be considered in BAV patients, yet further research is warranted to validate these insights.