Funding Acknowledgements Type of funding sources: None. Purpose Aortic dilatation is associated with acute aortic pathology. Cardiac magnetic resonance (CMR) data in asymptomatic elite athletes is lacking. Therefore, we investigated the prevalence of aortic dilatation in a cohort of elite-level athletes using CMR. Methods We performed a cross-sectional study of aortic dimensions among elite-level (national-, international-, Olympic-, Paralympic-level or comparable) athletes. All athletes were asymptomatic and examined during pre-participation screening. Each underwent CMR with 3D whole heart in diastole (1.5 mm voxel) for aortic measurements, next to cine imaging, late gadolinium enhancement (LGE), and T1-mapping. We defined dilatation as 38 and 40 mm at the aortic root (sinus of Valsalva cusp-cusp), 27 and 31 mm at the sinotubular junction, and 23 and 26 mm at the level of the diaphragm, in male- and female athletes, respectively. Athletes were grouped for having 0- (normal), 1-, 2- or 3 measurements above cut-off values. Results We screened 156 athletes, 41% female, with a mean age (±SD) of 28±7 and body surface area (BSA) of 2.0±0.2 m2. Mean aortic dimensions were 33±4 mm for the sinus of Valsalva, 28±3 mm for the sinotubular junction, 20±3 mm for the aorta at diaphragm. We observed indexed end-diastolic volumes (EDVi) of 122±20 and 123±20 ml/m2, indexed end-systolic volumes (ESVi) of 53±13 and 54±16 ml/m2, stroke volumes (SV) of 129±36 and 126±39 ml, and ejection fractions (EF) of 56±5 and 55±6 %, in the left- (LV) and right ventricle (RV), respectively Fifty-three (34%) athletes, of which 45% female, had 1 or 2 aortic measurements above conventional cut-off values (Table 1). Eleven (7%), 18% female, had 2 aortic measurements above cut-off values. No athlete had all 3 measurements above cut-offs values. Athletes with 2 dilated measurements compared to athletes with 1 or 0 dilated measurements, had greater LV EDVi (145±19 vs. 119±18 vs. 120±19 ml/m2, p<0.001), greater RV EDVi (142±18 vs. 119±17 vs. and 122±20 ml/m2, p=0.002), greater LV ESVi (66±10 vs. 51±13 vs. 52±13 ml/m2, p=0.002), greater RV ESVi (66±10 vs. 53±13 vs. 53±17 ml/m2, p=0.039), greater LV SV (156±26 vs. 132±35 vs. 125±36 ml, p=0.020), and greater RV SV (152±25 vs. 130±34 vs. 121±41 ml, p=0.031), 2- vs, 1- vs. 0 dilated segments, respectively (Table 1, Figure 1). Athletes with dilated measurements had no LGE (excluding the hinge point), no difference in T1-mapping times, or LV- and RV EF, compared to athletes without dilated measurements. Conclusion One in three elite-athletes has dilatation in one or more aortic segments, including the sinus of Valsalva, sinotubular junction, or the aorta at diaphragm. Athletes with 2 dilated measurements (7%) had greater LV- and RV EDVi, ESVi, and SV, suggesting an association with ventricular volumes. Our findings in asymptomatic elite athletes, with normal EF and no LGE and comparable T1-mapping times, could be a sign of an outspoken physiological sports adaptation, instead of pathology.
Funding Acknowledgements Type of funding sources: None. Background Late gadolinium enhancement (LGE) demonstrates regional differences in myocardial extracellular volume, such as seen in myocardial fibrosis, and is associated with diverse cardiac diseases and is a predictive factor for sudden cardiac death. Earlier findings suggest an LGE prevalence of 7% in endurance athletes of varying age and exercise exposure. However, findings for (potentially benign) LGE indices in athletes performing at elite-level are lacking. Purpose To establish a specific baseline for LGE findings on CMR in apparently healthy, elite-level athletes. Methods We performed a cross-sectional assessment of hinge point late gadolinium enhancement (HP-LGE) in elite athletes (national-, international-, Olympic-, Paralympic-level or comparable). All athletes were asymptomatic and examined during pre-participation cardiovascular screening. Each underwent CMR using 3 Tesla- (Philips) or 1½ Tesla- (Siemens) MRI-scanners including short-axis cine imaging, LGE, and T1-mapping. CMR data were analysed using cvi42, statistical analyses using R. Athletes with HP-LGE were compared to athletes without HP-LGE. Results We screened 210 athletes, 34% female, with a mean age (±SD) of 28±7 and body surface area (BSA) of 2.0±0.2 m2 participating in road cycling (n=38), field hockey (n=28), water polo (n=27), soccer (n=21), rowing (n=18), swimming (n=13), track cycling (n=12), tennis (n=10), sailing (n=10), para-cycling (n=7), and miscellaneous (n=26) sports. We observed indexed end-diastolic volumes (EDVi) of 119±20 and 123±20 ml/m2, stroke volumes 131±33 and 127±37 ml, and ejection fractions of 56±5 and 54±6 %, in the left- (LV) and right ventricle (RV), respectively. Eighty-four (40%) athletes had HP-LGE. Proportionally, fewer female athletes had HP-LGE as compared with men (24 vs 41 %, p=0.014). Athletes with HP-LGE had greater LV- and RV EDVi (123±20 and 127±20 ml/m2 vs. 117±19 and 120±19 ml/m2, p=0.02 and p=0.01; for LV and RV, respectively), lower RV ejection fractions (53±5 vs. 55±6, p-value 0.04), smaller estimated global extra cellular volumes of the LV (24 vs 25 %, p=0.01). There were no differences in indexed LV- and RV end-systolic volumes, LV- and RV stroke volumes, LV ejection fraction and indexed wall mass, global native-, or contrast-enhanced T1 times in athletes with and without HP-LGE. Conclusion Late gadolinium enhancement in the hinge point is present in 40% of asymptomatic elite athletes. Athletes with HP-LGE were more frequently men, had higher LV- and RV EDVi, suggesting an association with ventricular volumes. Our findings in asymptomatic, elite athletes, with normal ventricular function and T1 times, suggest that HP-LGE could be a sign of physiological sports adaptation instead of an early sign of pathology. Further studies are warranted to investigate if HP-LGE is associated with long-term cardiac changes or the development of cardiac pathology.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.