Prevalence and progression of aortic root dilatation in highly trained young athletes

Abstract

ObjectivesAortic root dilatation is reported in young athletes; however, it is unclear whether such remodelling is physiological or, whether it represents a potential aortopathy. This observational study investigated the prevalence and progression of aortic root dilatation in young athletes competing at regional or national level.MethodsBetween 2003 and 2015, 3781 athletes aged 19±5.9 years (63.3% male) underwent echocardiography as part of a cardiac screening programme to identify athletes with structural abnormalities. Athletes trained for an average of 16.7 hours per week. Aortic diameter was measured at the level of sinuses of Valsalva. Results were compared with 806 controls. Athletes with an enlarged aortic diameter were followed up for 5±1.5 years.ResultsAthletes revealed a larger mean aortic diameter compared with controls (28.3±4.1 vs 27.8±4.1 mm; p=0.01). The 99th percentile value for aortic diameter in the athlete cohort was defined as the upper limit and was 40 mm in males and 38 mm in females. The aortic diameter measured >40 mm in five male (0.17%) (40–43 mm) and >38 mm in six female (0.4%) (39–41 mm) athletes. During follow-up, none of the athletes with an enlarged aortic diameter showed progressive aortic enlargement compared with the first assessment (40.6±0.9 vs 40.5±0.7 mm in males; (p=0.111) and 38.3±0.6 vs 38.0±0.7 mm in females; (p=0.275)).ConclusionsA small minority (0.3%) of athletes reveal an enlarged aortic diameter. Medium-term follow-up does not reveal progressive enlargement of the aortic diameter indicative of aortopathy. Longer surveillance studies are necessary to elucidate the precise significance of an enlarged aortic diameter in athletes.

Echocardiographic measurements of aortic root diameter (ARD) in collegiate football Athletes at pre-participation evaluation

“…A recent study of 3781 young athletes (age: 19±5.9 years) had 5±1.5 years longitudinal follow-up of those athletes with an enlarged aortic diameter and found no progressive enlargement of the aortic diameter during that time 21. Their cohort had a larger mean ARD compared with controls and did not include American-style football athletes 21. This discrepancy in findings regarding the aetiology of increased ARD in some athletes presents opportunity for further research to better understand the timing of aortic remodelling and determine if there are clinical consequences to progressive dilation.…”

“…However, Pelliccia et al followed several athletes with dilated aortas >40 mm and without stigmata of Marfan’s syndrome over several years after conclusion of their athletic careers and found that the largest increases in aortic dimension in athletes tends to occur in midlife as opposed to years with high volumes of training 6. A recent study of 3781 young athletes (age: 19±5.9 years) had 5±1.5 years longitudinal follow-up of those athletes with an enlarged aortic diameter and found no progressive enlargement of the aortic diameter during that time 21. Their cohort had a larger mean ARD compared with controls and did not include American-style football athletes 21.…”

Aortic root in competitive sports: eyes on the older athlete

“…Current data from different groups of athletes suggest that training on its own has only a limited impact on physiological aortic root remodelling (figure 1). 3 4 This impression is strongly reinforced by the results presented by Gati et al 5 in this issue of Heart , who echocardiographically investigated aortic root diameters in 3781 athletes aged 19±5.9 years, in whom hereditary thoracic aortic disease was definitely ruled out. These aortic dimensions were similar to a control population of 806 individuals when corrected for BSA.…”

Heartbeat: Aortic size in athletes

“…Athletes tend to have larger aortic dimensions than sedentary controls however it is unclear if this represents an aortopathy or is a normal physiological response to physical conditioning. To better understand the clinical implications of an enlarged aortic root in young athletes, Gati and colleagues1 compared aortic size and clinical outcomes in 3781 athletes with no evidence of a genetic aortopathy (mean age 19 years, 63% male) to 806 control subjects. This study found an enlarged aortic diameter in only 0.3% of athletes with no evidence of progressive enlargement over 5 years of follow-up.…”

“…The two other points they emphasise are that1 (1) reproducibility of aortic root measurements is not ideal and needs to be considered in patient follow-up and2 (2) pathological aortic dilation most often occurs in older individuals raising the concern that athletic activity as a teenager or young adult might affect aortic size decades later. They conclude that: ’While a liberal approach is probably warranted in the young athlete with mild aortic root dilatation, clinicians should remain vigilant in athletes at the end of their sports career and in later life.…”