Introduction:
Central arterial pressure rises to much higher levels during heavy isometric exercise compared to other forms of exercise. For this reason, patients with bicuspid aortic valves (BAV) are often restricted from heavy isometric exercise. Although this approach may be theoretically appealing, no data exists regarding the efficacy of this activity restriction.
Methods:
Patients between the 12-19 years old with BAV were approached during a routine clinic visit. Patients were excluded if they had a diagnosed syndrome or had undergone a procedure involving the aortic valve. Patients were assumed to have been exercise restricted, regardless of aortic dimensions. Patients completed a questionnaire regarding frequency and intensity of isometric exercise during the 12-month period prior to the visit. We then compared aortic dimensions and qualitative (1-4 scale) estimates of aortic insufficiency (AI) from an echocardiogram performed during the current visit and one obtained 2-5 years previously, using paired t-tests and multivariable regression controlling for age, gender, and participation in isometric exercise.
Results:
In this unique data set of 37 individuals (41% female, average age 14.8 years), 6 (16%) participated in isometric exercise. There was no significant increase in the aortic root Z-score (0.004 [95
th
CI -0.20, 0.21) or in the ascending aorta Z-score (0.11 [95
th
CI, -0.15, 0.37], p=0.4) between the first and second visits. Further, there was no differences in the change aortic root Z-score (β=-0.39, p=0.39) and ascending aorta Z-score (β=-0.30, p-0.699) between those who participated in isometric exercise and those who did not. However, although the sample size in this preliminary group of patients was small, the increase in AI severity among those participating in isometric exercise was clinically significant and approached statistical significance (β=0.37, p=0.1). These results did not change even after controlling for age, gender, and time between echocardiograms.
Conclusion:
Most adolescents with BAV follow recommendations to limit isometric exercise. Time-related changes in aortic dimensions were similar among patients who refrained from isometric exercise and those who engaged in isometric exercise. AI however may have progressed more rapidly in those who participated in isometric exercise.
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