Journal of the American Heart Association · 2026
Impact of Extravalvular Remodeling on Wearable Smartwatch-Recorded Physical Activity in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Symptomatic Aortic Stenosis.
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Androshchuk Vitaliy, Long Edouard, Chehab Omar, Wilcox Joshua, McDonaugh Benedict, Rajani Ronak, Prendergast Bernard, Patterson Tiffany, Redwood Simon
Аннотация
BACKGROUND: Wearable smartwatches enable objective quantification of physical activity. This study evaluated the association of extravalvular cardiac damage in aortic stenosis with smartwatch-recorded physical activity before and after transcatheter aortic valve implantation (TAVI).
METHODS: Patients with severe symptomatic aortic stenosis were dichotomized into cardiac damage stages 0 to 2 (left-heart dysfunction) and stages 3 to 4 (pulmonary/right-heart dysfunction) by echocardiography. All patients received a Fitbit smartwatch for 7 days of continuous monitoring before transcatheter aortic valve implantation and at 6-month follow-up. Regression models determined significant predictors of total daily step count and moderate to vigorous physical activity (MVPA).
RESULTS: Within the study cohort (stages 0-2: 43 [50.6%]; stages 3-4: 42 [49.4%]), all patients showed significant improvement in physical activity from baseline to follow-up (all P<0.001). Patients in stages 3 to 4 had significantly lower total daily step count and MVPA at baseline and follow-up, as well as a smaller improvement in MVPA (all P<0.05). Relative to stages 0 to 2, stages 3 to 4 were significantly associated with lower step count and MVPA at baseline (step count: β=-1453.8 [95% CI, -2351.3 to -554.2], P=0.002; MVPA: β=-12.9 [95% CI, -24.3 to -1.5], P=0.027) and follow-up (step count: β=-1438.1 [95% CI, -2453.9 to -422.3], P=0.006; MVPA: β=-27.4 [95% CI, -47.7 to -7.1], P=0.009), as well as less improvement in MVPA (β=-14.5 [95% CI, -28.4 to -0.48], P=0.043) after transcatheter aortic valve implantation.
CONCLUSIONS: The extent of cardiac damage before transcatheter aortic valve implantation has an important impact on physical activity, both at baseline and following intervention. Future studies should examine whether smartwatch-measured activity predicts death across cardiac damage stages and whether cardiac rehabilitation improves outcomes in aortic stenosis with advanced remodeling.
METHODS: Patients with severe symptomatic aortic stenosis were dichotomized into cardiac damage stages 0 to 2 (left-heart dysfunction) and stages 3 to 4 (pulmonary/right-heart dysfunction) by echocardiography. All patients received a Fitbit smartwatch for 7 days of continuous monitoring before transcatheter aortic valve implantation and at 6-month follow-up. Regression models determined significant predictors of total daily step count and moderate to vigorous physical activity (MVPA).
RESULTS: Within the study cohort (stages 0-2: 43 [50.6%]; stages 3-4: 42 [49.4%]), all patients showed significant improvement in physical activity from baseline to follow-up (all P<0.001). Patients in stages 3 to 4 had significantly lower total daily step count and MVPA at baseline and follow-up, as well as a smaller improvement in MVPA (all P<0.05). Relative to stages 0 to 2, stages 3 to 4 were significantly associated with lower step count and MVPA at baseline (step count: β=-1453.8 [95% CI, -2351.3 to -554.2], P=0.002; MVPA: β=-12.9 [95% CI, -24.3 to -1.5], P=0.027) and follow-up (step count: β=-1438.1 [95% CI, -2453.9 to -422.3], P=0.006; MVPA: β=-27.4 [95% CI, -47.7 to -7.1], P=0.009), as well as less improvement in MVPA (β=-14.5 [95% CI, -28.4 to -0.48], P=0.043) after transcatheter aortic valve implantation.
CONCLUSIONS: The extent of cardiac damage before transcatheter aortic valve implantation has an important impact on physical activity, both at baseline and following intervention. Future studies should examine whether smartwatch-measured activity predicts death across cardiac damage stages and whether cardiac rehabilitation improves outcomes in aortic stenosis with advanced remodeling.