Exercise-induced pulse pressure augmentation is positively associated with exercise capacity in patients after transcatheter aortic valve implantation

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Aims 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 VO 2 ) during cardiopulmonary exercise testing. The association between ΔPP and exercise capacity (peak VO 2 ) 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 VO 2 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 VO 2 after TAVI. The physiological determinants and clinical utility of this association require prospective validation.

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