A Meta-Analysis of Aortic Root Size in Elite Athletes

Abstract

and atrium (Appendix I in the online-only Data Supplement). In addition, we manually reviewed the references of included studies Background-The aorta is exposed to hemodynamic stress during exercise, but whether or not the aorta is larger in athletes is not clear. We performed a systematic literature review and meta-analysis to examine whethere athletes demonstrate increased aortic root dimensions compared with nonathlete controls. Methods and Results-We searched MEDLINE and Scopus from inception through August 12, 2012, for Englishlanguage studies reporting the aortic root size in elite athletes. Two investigators independently extracted athlete and study characteristics. A multivariate linear mixed model was used to conduct meta-regression analyses. We identified 71 studies reporting aortic root dimensions in 8564 unique athletes, but only 23 of these studies met our criteria by reporting aortic root dimensions at the aortic valve annulus or sinus of Valsalva in elite athletes (n=5580). Athletes were compared directly with controls (n=727) in 13 studies. On meta-regression, the weighted mean aortic root diameter measured at the sinuses of Valsalva was 3.2 mm (P=0.02) larger in athletes than in the nonathletic controls, whereas aortic root size at the aortic valve annulus was 1.6 mm (P=0.04) greater in athletes than in controls. Conclusions-Elite athletes have a small but significantly larger aortic root diameter at the sinuses of Valsalva and aortic valve annulus, but this difference is minor and clinically insignificant. Clinicians evaluating athletes should know that marked aortic root dilatation likely represents a pathological process and not a physiological adaptation to exercise. .).The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

Cardiac Imaging in Athletes

“…Therefore, marked aortic root dilatation should be considered a pathological process in athletes. 35 …”

Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport

“…However, very few studies have explored this issue. 1 A challenge surrounding aortic root dilation in athletes is the definition of the upper limits of this anatomic segment. Recent guidelines of the European Society of Cardiology state that aortic diameters do not usually exceed 40 mm.…”

“…3,4 Another issue is that most studies have only categorized sports as either strength-type or endurance-type. 1 Nevertheless, Mitchell et al provide a more detailed classification determined by the static and dynamic components of each sport. 5 The aim of this study is to establish the physiological limits of aortic remodeling associated with prolonged and intense exercise training in a large population of healthy elite athletes, taking into account cardiovascular demands of each sport in terms of static and dynamic component as stated in Mitchell's sport classification.…”

Age-Specific Features of Soccer Players' Heart Dimensions

“…D'Andrea et al [4] concluded that the aortic root dimension was significantly greater in strength-trained athletes (n=245) than in age-and gender-matched endurance athletes (n=370). On the contrary, Iskander et al [5] showed that male endurance athletes had greater AO diameters incomparison to strength athletes and controls, and strength athletes showed a non-significant trend towards greater dimensions at AO than controls. Pelliccia et al [6] assessed athletes of 28 different sports disciplines (n=1300) and showed that the aortic root dimension could be explained by weight, height, left ventricular mass and age, with the type of sports having a significant but lower impact.…”