Aortic root remodelling in competitive athletes

Abstract

Background Controversy remains about the cut-off limits for detecting aortic dilatation in athletes, particularly in large-sized individuals. The allometric scaling model has been used to obtain size-independent measurements in cardiovascular structures in the general population. Aim The purpose of this study was to validate the use of allometric scaling in the measurement of the aortic root for competitive athletes and to offer reference values. Methods This was a cross-sectional study that analyses the dimensions of aortic root found in the echocardiogram performed as part of pre-participation sports screening in competitive athletes between 2012–2015. Beta exponents were calculated for height and body surface area in the whole cohort. In order to establish whether a common exponent could be used in both genders the following model was assessed y = a xb*exp(c*sex). If a common exponent could not be applied then sex-specific beta exponents were calculated. Results Two thousand and eighty-three athletes (64% men) were included, from a broad spectrum of 44 different sports disciplines, including basketball, volleyball and handball. The mean age was 18.2 ± 5.1 years (range 12–35 years) and all athletes were Caucasian, with a training load of 12.5 ± 5.4 h per week. Indexed aortic root dimension showed a correlation with ratiometric scaling by body surface area (r: −0.419) and generated size independence values with a very light correlation with height (r: −0.084); and with the allometric scaling by body surface area (r: −0.063) and height (r: −0.070). The absolute value of aortic root was higher in men than in women ( p < 0.001). These differences were maintained with allometric scaling. Conclusion Size-independent aortic root dimension values are provided using allometric scaling by body surface area and height in a large cohort of competitive athletes. Aortic root values were larger in men than in women, both in absolute values and after allometric scaling. The use of these indexed aortic reference ranges can be useful for the early detection of aortic pathologies.

Focus on exercise and sport cardiology

“…Here, the study presented by Abuli and colleagues on a cohort of 2092 athletes aged between 12 and 35 years indexed the aortic root size by two different scaling models: ratiometric and allometric scaling. 11 In brief, the authors confirmed that the aortic root size in healthy trained athletes is within normal ranges established for the general population, and that sports with a high dynamic component are related to significantly larger aortic root size. Furthermore, the authors showed that allometric and ratiometric scaling to height provides almost perfect size-independent models, as shown by the lowest existing relationship with body surface area and height using these scaling methods.…”

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

“…A third hypothesis concerns ethnicity. Our sample comprised 16% of Pacific Islanders and 9% of Afro‐Caribbeans, whereas previous studies included few athletes from these ethnic backgrounds 3,5,15,16,23‐28 . However, the prevalence of dilated aorta was significantly higher in a sports population of similar size and with a high Afro‐Caribbean component 29 .…”

“…Our sample comprised 16% of Pacific Islanders and 9% of Afro-Caribbeans, whereas previous studies included few athletes from these ethnic backgrounds. 3,5,15,16,[23][24][25][26][27][28] However, the prevalence of dilated aorta was significantly higher in a sports population of similar size and with a high Afro-Caribbean component. 29 The only study on the heart of Pacific rugby players to date 18 did not focus on the aorta.…”

Tell me the name of your sport and I will tell you the size of your aorta

“…12 The study presented by Abulı´et al has three main findings: 1) the aortic root size in healthy trained athletes is within normal ranges established for the general population; 2) sports with a high dynamic component are related to significantly larger aortic root size; and 3) allometric and ratiometric scaling to height provides almost perfect size-independent models, as shown by the lowest existing relationship with BSA and height using these scaling methods. 13 This is one of the largest databases available to date. Moreover, this is the first one that provides reference aortic root values based on this classification of sports in skill, power, mixed and endurance.…”

“…has three main findings: 1) the aortic root size in healthy trained athletes is within normal ranges established for the general population; 2) sports with a high dynamic component are related to significantly larger aortic root size; and 3) allometric and ratiometric scaling to height provides almost perfect size-independent models, as shown by the lowest existing relationship with BSA and height using these scaling methods. 13…”