Abstract

Background: Individuals with aortic dilation (≥4.0cm) or aneurysm (≥4.5cm) are encouraged to avoid high-intensity sports. However, the incidence of aortic dissection in patients with bicuspid aortic valve (BAV) is low. Restricting physical activity can also impact cardiovascular outcomes. Aims: The impact of exercise on progressive BAV aortopathy is not well understood. This observational study examines the association of exercise intensity with change in aortic dimensions in BAV patients with aortic dilation. Methods: Data was collected from a prospectively enrolled BAV cohort established by the Bluhm Cardiovascular Institute (BCVI) in 2005. BAV patients with aortic diameter ≥4.0cm on CT/MRI and without prior aortic intervention were included. Activity intensity was graded based on AHA/ACC Classification of Sports. Patients who engaged in high dynamic/static component activities for ≥4 hours/week were classified as high-intensity exercisers. Those who engaged in the same activities for <4 hours/week or engaged in low static/dynamic activities or no activity were classified as less than high-intensity exercisers. Results: There were 65 high-intensity exercisers and 44 less than high-intensity exercisers. Median follow-up was 9 years (IQR 5.5-11.2). There were no significant differences in demographics, risk factors, or beta-blocker and statin use (Table 1). No statistically significant differences were observed in annual rate of change of the maximal dimension of the sinus of Valsalva (0.09 vs 0.19mm, p=0.15), sinotubular junction (0.12 vs 0.16mm, p=0.60), mid-ascending aorta (0.25 vs 0.24mm, p=0.88), or proximal ascending aortic arch (0.14 vs 0.21mm, p=0.21) between the two groups (Figure 1). Conclusions: High-intensity exercise was not associated with progressive aortic dilation in patients with BAV. This observation warrants further study of exercise restrictions in patients with BAV and aortic dilation as these may deter otherwise healthful cardiovascular behaviors.