Aortic dilatation: Value of echocardiography in the systematic assessment of elite rugby players in the French National Rugby League (LNR)

Abstract

The value of echocardiography in the screening of athletes in addition to the electrocardiogram is debated and still unclear. 336 rugby players in French professional divisions (Top 14, Pro D2) were prospectively assessed with electrocardiogram and echocardiography. 75% were Caucasian, 16.4% Pacific Islanders, and 8.6% Afro‐Caribbean. Six (1.8%) players had electrocardiogram abnormalities, exclusively negative T waves. Twenty‐one (6.25%) of them had abnormal echocardiography findings: one possible early hypertrophic cardiomyopathy, one anomalous origin of coronary artery, two left ventricular dilatations, one isolated bicuspid aortic valve, two aortic regurgitations, and 14 ascending aortic dilatations. The median aortic diameter was modestly correlated with age: 32 mm [23‐48] in players aged ≤25 years vs 33.5 mm [24‐50] in those aged >25 years (P = 0.02, correlation coefficient −.01). This tendency increased with cumulative hours of weight training: 34 mm [24‐50] in forwards vs 32 mm [25‐44] in backs (P = 0.01); and ethnicity, with Pacific Islanders having higher values in both raw data and body surface area or height‐indexed data than Afro‐Caribbeans and Caucasians: 34 [25‐50] vs 32 [27‐48] and 33 [23‐49] mm (P = 0.017); 15 [12.2‐21] vs 14.8 [11‐19.9] and 14.8 [10‐20.9] mm/m2 (P < 0.0001); 18.5 [14‐25] mm/m vs 17.4 [14.8‐25] mm/m and 17.6 [12.2‐25.3] mm/m (P = 0.0125). In a population of professional rugby players, echocardiography was contributive. The main anomaly was aortic dilatation (14/336, 4.2%). While this is proportionally much higher than in other sports, the cutoffs need to be defined more precisely by including the criterion of ethnicity, as is already the case for electrocardiography.

May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review

“…Rowing is characterized by a combination of dynamic and static exercise, with repetitive surges in arterial blood pressure that can explain the higher prevalence of aortic dilatation in this subset of master-level athletes. Rugby players have been recently identified as another group at risk of aortopathy [ 134 ]. Kay et al found an unexpectedly high prevalence (41%) of aortic root dilatation (>40 mm) in middle-aged (45 ± 13 years) former elite rugby players.…”