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Updated: Aug 19, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Exercise-induced pulse pressure augmentation is positively associated with exercise capacity in patients after
Kotaro Takizawa1, Daichi Kobayashi1, Shinya Tajima1
1Department of Rehabilitation, Sakakibara Heart Institute, Tokyo, Japan.
Abstract:
Although transcatheter aortic valve implantation (TAVI) improves outcomes in elderly patients with aortic stenosis, many continue to have reduced exercise capacity. While higher resting pulse pressure (PP) has been linked to worse prognosis, the impact of exercise-induced PP changes remains unclear. This study examined the association between PP change (ΔPP) during exercise and exercise capacity after TAVI.
Methods:
This single-center retrospective study included patients who underwent transfemoral TAVI at the Sakakibara Heart Institute between 2014 and 2024 and subsequently participated in outpatient cardiac rehabilitation. ΔPP was defined as the difference in PP between rest and peak oxygen uptake (peak VO2) during cardiopulmonary exercise testing. The association between ΔPP and exercise capacity (peak VO2) was evaluated using multivariable linear regression analyses.
Results:
A total of 71 patients were analyzed (median age 82 years (range 70-92), 46% women). The High ΔPP group (ΔPP > 47 mmHg, n = 35) showed significantly higher peak VO2 than the Low ΔPP group (19.8 vs. 15.6 mL/kg/min, p < 0.01). In multivariable linear regression models adjusted for age and sex, widened ΔPP remained associated with higher exercise capacity (coefficient 0.55 per 10 mmHg; 95% confidence interval 0.06-1.04; p = 0.029).
Conclusions:
In this single-center retrospective cohort, greater exercise-induced ΔPP was associated with higher peak VO2 after TAVI. The physiological determinants and clinical utility of this association require prospective validation.
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