What is the association between lifelong exercise volumes, valvular function and aortic diameters in subjects with a bicuspid aortic valve?

Abstract

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Hartstichting and Stichting Hartekind Background/Introduction Subjects with bicuspid aortic valve disease (BAV) have a higher risk of developing valvular and aortic complications. There is debate if hemodynamic stress associated with long-term exercise training may accelerate the development of complications. Current exercise guidelines are rather restrictive and primarily based on expert opinion. Hence, more insight is needed into the association between exercise volumes and disease characteristics in BAV subjects, especially since exercise training is a powerful strategy to improve cardiovascular health. Purpose To assess the association between lifelong exercise volumes and disease characteristics in BAV subjects. Methods We enrolled BAV subjects ≥35 years old who have not undergone an aortic valve or aorta intervention. Lifelong physical activity was determined using a validated questionnaire and quantified as Metabolic Equivalent of Task minutes per week (MET-min/wk). Participants were classified as 1) insufficiently active, 2) active, or 3) highly active, based on their lifelong physical activity volumes (<500, 500-1000 and >1000 MET-min/wk, respectively). Disease characteristics were assessed from echocardiographic images that were obtained during the most recent visit to our outpatient clinic, whereas patient characteristics were extracted from electronic health records. Results 152 participants (54±10 years, 55% male) were included of which n=59 insufficiently active, n=47 active and n=46 very active. Median lifelong physical activity volumes were 235 [108-387], 713 [653-828] and 1499 [1198-1875] MET-min/wk (p<0.001), respectively. Subject characteristics did not differ across groups (Table 1). No difference was found in aortic valve dysfunction across exercise volume groups, measured as peak aortic valve velocity (1.8 [1.5-2.4] m/s vs. 1.7 [1.4-2.6] m/s vs. 1.8 [1.5-2.5] m/s, p = .52) and presence of moderate-severe aortic valve regurgitation (n=7 (12%) vs. n=7 (15%) vs. n=6 (13%), p=.89) Also, aortic diameters at the level of the sinus of Valsalva (36.0±4.9 mm vs 35.8±5.5 mm vs 36.7±6.1 mm, p=.69) and ascending aorta (36.5±6.3 mm vs 39.0±7.0 mm vs 37.5±7.0 mm, p=.18) did not significantly differ across groups. Conclusion Lifelong exercise volumes are not associated with characteristics of disease severity in BAV subjects who have not undergone an aortic valve or aorta intervention. These observations may support a less cautious approach for habitual physical activity and exercise training in BAV subjects, so they can profit from the cardiovascular health benefits of a physically active lifestyle.