Associations Between Lifelong Exercise Characteristics, Valvular Function And Aortic Diameters In Bicuspid Aortic Valve Subjects

PURPOSE There is debate whether exercise-induced hemodynamic stress may accelerate the development of valvular dysfunction and aortic dilatation in subjects with a bicuspid aortic valve (BAV). Therefore, we assessed the association between lifelong exercise characteristics, valvular dysfunction and aortic dilatation in BAV subjects. METHODS Subjects with BAV reported their lifelong exercise patterns and were classified as insufficiently active (<500 metabolic equivalent of task minutes per week (MET-min/wk), active (500-1000 MET-min/wk) or highly active (≥1000 MET-min/wk). Dominant exercise intensity (moderate(3-6 MET) or vigorous (≥6 MET)) and sport type (skill, power, mixed or endurance) were based on total exercise volume. Echocardiography was used to assess the presence of aortic stenosis (AS) or regurgitation (AR) and to measure diameters at the sinus of Valsalva (SV) and ascending aorta (AA). Aortic dilatation was defined as a Z-score ≥ 2. RESULTS 407 subjects (42 ± 17 years old) were included of which 133 inactive, 94 active and 180 highly active. Moderate-to-severe AS or AR was present in 96 (23.6%) and 81 (19.9%) subjects. SV and AA diameters were 34.8 ± 6.6 and 36.5 ± 8.1 mm, while a Z-score ≥ 2 was present in 74 (18.2%) and 194 (47.7%) subjects. Exercise volume was not associated with valve dysfunction or aortic dilatation. Performance of vigorous intensity exercise and mixed sports were associated with lower odds ratios for moderate-to-severe AS (ORadjusted: 0.43 (0.20-0.94) p = 0.035 and ORadjusted: 0.47 (0.23-0.95) p = 0.035), while no associations were found with AR or dilatation. CONCLUSION No deleterious associations were found between lifelong exercise characteristics, valvular dysfunction and aortic dilatation in BAV subjects. Vigorous intensity and mixed sports were associated with lower odds ratios for moderate-to-severe AS. These observations suggest that exercise does not induce deleterious cardiovascular adaptations in BAV subjects .