Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome

Braverman, Alan C.; Harris, Kevin M.; Kovacs, Richard J.; Maron, Barry J.

doi:10.1161/cir.0000000000000243

Cited by 86 publications

(51 citation statements)

References 33 publications

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“…We found that being a former elite athlete was associated with a larger ascending aorta independent of size, age, race, blood pressure, a history of hypertension or diabetes, current smoking status, or lipid profile. Indeed, even after adjustment for these parameters, former NFL athletes had a twofold higher risk of having aortic dilation, as defined by an aorta dimension greater than 40 mm 7, 13, 15 . When considering the type of NFL player position, prediction of aortic dilation was driven primarily by linemen as opposed to non-linemen.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of these studies consistently demonstrate that the aorta in active elite athletes falls within the established limits for the general population. The aorta is rarely (<2%) greater than 40 mm; this arbitrary cut off is used in the updated American Heart Association/American College of Cardiology (ACC) Eligibility and Disqualification Recommendations as a threshold to indicate aortic dilation with recommendations for comprehensive evaluation for an underlying genetic aortopathy, avoidance of intense weight training and close surveillance if above this threshold 13 . However, in a meta-analysis by Iskandar et al, elite athletes did have significantly larger aortas when compared to sedentary controls, in the order of 3.2 mm larger at the level of the sinus of Valsalva 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Former NFL athletes who played in the tackle, guard, center, defensive tackle, defensive end, or linebacker were classified as linemen; those who played in the quarterback, running back, wide receiver, tight end, cornerback, safety, kicker, or punter position were classified as non-linemen. Aortic enlargement was defined as a mid-ascending aortic dimension greater than 40 mm based on the Task Force 7 (Aortic Disease) of the Eligibility and Disqualification Recommendations for Competitive Athletes with Cardiovascular Abnormalities and represents the 99 th percentile in male athletes 13, 14 . Aortic dimension greater than 40 mm is also a common threshold in which at least annual imaging surveillance is recommended and avoidance of intense weight lifting may be considered in athletes.…”

Section: Methodsmentioning

confidence: 99%

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Ascending Aortic Dimensions in Former National Football League Athletes

Gentry

Carruthers

Joshi

et al. 2017

Circ: Cardiovascular Imaging

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Background Ascending aortic dimensions are slightly larger in young competitive athletes compared to sedentary controls, but rarely greater than 40 mm. Whether this finding translates to aortic enlargement in older, former athletes is unknown. Methods and Results This cross-sectional study involved a sample of 206 former National Football League (NFL) athletes compared with 759 male subjects from the Dallas Heart Study-2 (DHS) (mean age 57.1 and 53.6 years respectively, p < 0.0001; body surface area of 2.4 and 2.1 m2 respectively, p < 0.0001). Mid-ascending aortic dimensions were obtained from computed tomographic scans performed as part of a NFL screening protocol or as part of the DHS. Compared to a population based control group, former NFL athletes had significantly larger ascending aortic diameters (38±5 vs. 34±4 mm; p<0.0001). A significantly higher proportion of former NFL athletes had an aorta of greater than 40 mm (29.6% versus 8.6%, p<0.0001). After adjusting for age, race, body surface area, systolic blood pressure, history of hypertension, current smoking, diabetes, and lipid profile the former NFL athletes still had significantly larger ascending aortas (p<0.0001). Former NFL athletes were twice as likely to have an aorta greater than 40 mm after adjusting for the same parameters. Conclusions Ascending aortic dimensions were significantly larger in a sample of former NFL athletes after adjusting for their size, age, race and cardiac risk factors. Whether this translates to an increased risk is unknown and requires further evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Ascending Aortic Dimensions in Former National Football League Athletes

Gentry

Carruthers

Joshi

et al. 2017

Circ: Cardiovascular Imaging

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“…Based on the revised Ghent criteria he meets the diagnostic criteria for having Marfan syndrome. Current recommendations from the American Heart Association and the American College of Cardiology (Task Force 7) state that patients with aortic disease or who have a condition associated with development of aortic disease should only participate in “low-intensity, noncompetitive exercise” (2). In line with these recommendations and the results of our assessments, subjects #1 and 2 have retired from competitive volleyball and are under close medical care.…”

Section: Discussionmentioning

confidence: 99%

Utility of Genetic Testing in Elite Volleyball Players with Aortic Root Dilation

Herrick

Davis

Vargas

et al. 2017

Medicine &Amp; Science in Sports &Amp; Exercise

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Basketball and volleyball attract individuals with a characteristic biophysical profile, mimicking features of Marfan Syndrome (MFS). Consequently, identification of these abnormalities can be lifesaving. Purpose To determine how physical examination, echocardiography, and genetic screening can identify elite volleyball players with a previously undiagnosed aortopathy. Methods We have performed cardiac screening on 90 US Volleyball National Team members and identified four individuals with dilated sinuses of Valsalva. This case series reports on three individuals who underwent a comprehensive genetics evaluation, including gene sequencing. Results Cardiac screening combined with genetic testing can identify previously undiagnosed tall athletes with an aortopathy, in the absence of non-cardiac findings of a connective tissue disorder. Subject #1 had a revised Ghent systems (RGS) score of 2 and a normal aortopathy gene panel. Subject #2 had a RGS score of 1 and genetic testing revealed a de novo disease causing mutation in the gene encoding fibrillin-1 (FBN1). Subject #3 had a RGS score of 4.0 and had a normal aortopathy gene panel. Conclusions Despite variable clinical features of MFS, dilated sinuses of Valsalva were found in 4.9% of the athletes. A disease-causing mutation in the FBN1 gene was identified in Subject #2, who had the lowest RGS but the largest aortic root measurement. Subjects #1 and #3, with the highest RGS, had a normal aortopathy gene panel. Our findings provide further evidence suggesting that a cardiac evaluation, including a screening echocardiogram, should be performed on all elite tall adult athletes independent of other physical findings. Genetic testing should be considered for athletes with dilated sinuses of Valsalva (male >4.2cm, female >3.4cm), regardless of other extra-cardiac findings.

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“…28 Guidelines recommended that, in general, athletes with increased aortic diameter (> 40 mm in adults) only participate in low-intensity dynamic and static sports (class IA sports). 29 A study has followed up a cohort of 732 individuals with Marfan's syndrome, all of them on pharmacological treatment, for 6 years. The risk for aortic events and SD remained low in those with aortic diameter between 35 and 49 mm.…”

Section: Introductionmentioning

confidence: 99%