Impact of Extravalvular Remodeling on Wearable Smartwatch‐Recorded Physical Activity in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Symptomatic Aortic Stenosis

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: =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.