Bicuspid aortic valve behaviour in elite athletes

Abstract

Aims To determine the prevalence and characteristics of bicuspid aortic valve (BAV) among elite athletes and to analyse the effect of long-term exercise training on their aortas. Methods and results Consecutive BAV and tricuspid aortic valve (TAV) elite athletes from a population of 5136 athletes evaluated at the Sports Medicine Center of the Spanish National Sports Council were identified using echocardiography. A total of 41 BAV elite athletes were matched with 41 TAV elite athletes, and 41 BAV non-athletic patients from three Spanish tertiary hospitals. Sixteen BAV elite athletes who had undergone at least two cardiac evaluations separated by more than 3 years were selected to assess their clinical course. The prevalence of BAV in elite athletes was 0.8%. The proximal ascending aorta was larger for both BAV groups in comparison to TAV athletes (P = 0.001). No differences in aortic diameters were found between BAV athletes and BAV non-athletes. In BAV elite athletes, the annual growth rates for aortic annulus, sinuses of Valsalva, sinotubular junction, and proximal ascending aorta were 0.04 ± 0.24, 0.11 ± 0.59, 0.14 ± 0.38, and 0.21 ± 0.44 mm/year, respectively. Aortic regurgitation was the only functional abnormality, but no significant progression was found. Conclusion High-intensity training and sports competition may not aggravate BAV condition during elite athletes’ careers. BAV elite athletes with mild-to-moderately dilated aortas may engage in high dynamic cardiovascular exercise without adverse consequences, although an echocardiographic follow-up is recommended.

Impact of Regular Physical Activity on Aortic Diameter Progression in Paediatric Patients with Bicuspid Aortic Valve

“…Thus, our data suggest that aortic root and ascending aorta dilation are not associated with regular physical activity in paediatric BAV patients during 2-year follow-up. The recommendations for sports eligibility for patients with BAV are consistent with the ACC/AHA valve and aorta guidelines [10,27], and should be tailored to anatomical concern and sport demands. In these subjects, the risk of SCD coming from aortic rupture or dissection is related most commonly to progressive valvular heart disease and aorta dilation [6].…”

“…It is a belief that increased blood pressure and aortic wall shear stress during physical exertion may increase the risk of aneurysm formation, aortic dissection or rupture in patients with genetic syndrome associated with aortopathies [10], but the role of regular physical training in BAV patients has not been fully evaluated. Recently, Boraita et al [27] studied the prevalence and the characteristics of BAV among elite athletes to analyse the effect of long-term exercise training on their aortas. Of 5316 elite athletes, 41 subjects with BAV were identified and, among these, 16 athletes had undergone two or more cardiac evaluations to assess their clinical course.…”

“…Recently, Boraita et al [ 27 ] studied the prevalence and the characteristics of BAV among elite athletes to analyse the effect of long-term exercise training on their aortas. Of 5316 elite athletes, 41 subjects with BAV were identified and, among these, 16 athletes had undergone two or more cardiac evaluations to assess their clinical course.…”

Bicuspid aortic valve and sports: From the echocardiographic evaluation to the eligibility for sports competition

“…At the end of follow‐up (mean 13 years follow‐up period), the authors observed that, in high‐risk athletes with BAV, the progression of valvular disease occurred independently from the former athletic activity and that the majority of athletes with mild BAV had a benign clinical course 52 . Furthermore, in competitive athletes with BAV, in a medium‐term follow‐up, exercise seems not to have a negative impact on left ventricle (LV) structure and function 51,53,54 . Stefani et al in a study evaluating 292 subjects with BAV (210 athletes, 23 ex‐athletes, and 59 controls) showed that there were no significant changes in LV morphology and function among the different BAV patterns in a 5‐year follow‐up 51 …”

“…Therefore, the current evidence would suggest that BAV elite athletes with mild to moderately dilated aortas may engage in high‐dynamic cardiovascular exercise without adverse consequences, although an echocardiographic follow‐up is strongly recommended 53 …”