Aortic distensibility is increasing in elite athletes

Erol, Mustafa Kemal; Yılmaz, Mustafa; Öztaşyonar, Yunus; Sevimli, Serdar; Senocak, Huseyin

doi:10.1016/s0002-9149(02)02260-9

Cited by 19 publications

(4 citation statements)

References 14 publications

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“…Thus, the results of this study suggest that the cause of LV hypertrophy was not due to reduced aortic distensibility in athletes, and conversely aortic distensibility increased while stiffness decreased in our athletic group. The results of Erol et al [43] are similar to ours. They found that aortic distensibility was increased by prolonged training in top-level athletes.…”

Section: Discussionsupporting

confidence: 90%

“…LV hypertrophy occurs due to increased afterload and aortic stiffness in patients with hypertension [42]. LV hypertrophy also occurs in athletes, but it is known that this form of hypertrophy is physiologic not pathologic, and that systolic and diastolic functions of the heart are not deteriorated [42, 43]. We also found similar results that athletes had greater LVMI than in the controls, although LV function was normal.…”

Section: Discussionsupporting

confidence: 80%

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Effects of Angiotensin-Converting Enzyme Polymorphism on Aortic Elastic Parameters in Athletes

et al. 2005

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Background: Physiologic adaptations in an athlete’s heart include increased left and right ventricular chamber size, left ventricular wall thickness and mass. Angiotensin-converting enzyme (ACE) is a key enzyme in angiotensin II production causing cardiac hypertrophy. The cloning of the ACE gene has made it possible to identifya deletion (D)-insertion (I) polymorphism that appears to affect the level of serum ACE activity. Therefore, the ACE genes, which have been shown to be polymorphic, could be candidate genes for large-artery stiffness. Methods: 56 endurance athletes and 46 sedentary subjects were included in this study, and they underwent both complete echocardiographic examination, and analysis of ACE insertion (I) and deletion (D) allele frequencies in peripheral blood. The aortic diameter was recorded by M-mode echocardiography at a level 3 cm above the aortic valve. Aortic systolic diameter was measured at the time of full opening of the aortic valve, and diastolic diameter was measured at the peak of QRS. Aortic strain, stiffness index and distensibility were calculated. Results: Left ventricular mass index and left ventricular ejection fraction were significantly higher in athletes than controls (p < 0.001). The aortic distensibility index and strain were significantly greater in athletes compared with controls (respectively: 5.8 ± 2.7 vs. 4.7 ± 1.8 cm^–2 dyn^–1 10^–6, p = 0.017; 12.3 ± 2.4 vs. 9.3 ± 3.1, p < 0.001). The aortic stiffness index was significantly lower in athletes than in controls (4.8 ± 1.9 vs. 6.1 ± 2.1, p < 0.001). The aortic distensibility index and strain were statistically different in ACE DD vs. DI groups and DD vs. II groups of athletes. The aortic stiffness index was statistically different in ACE DD vs. II groups of athletes. Aortic parameters were similar according to ACE genotypes in controls. Conclusion: The results of this study indicate that aortic distensibility was increased by prolonged training in endurance athletes, particularly in those with the ACE II genotype. This effect represents an extracardiac adaptation to chronic prolonged training in athletes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 80%

Effects of Angiotensin-Converting Enzyme Polymorphism on Aortic Elastic Parameters in Athletes

et al. 2005

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“…In turn, the larger aortic diameters found in athletes might reflect a physiological adaptation to exercise training--and in fact part of the cardiovascular remodeling associated with the so-called athlete's heart. In this effect, although not confirmed in the present study, endurance athletes have also been previously reported to present with an increased aortic distensibility and less stiffness compared with untrained individuals (21,22), which has been considered a "favorable" (or healthy) response to exercise training. Indeed, arterial stiffness is a major determinant of increased systolic and pulse pressure that can lead to several cardiovascular complications and events, including left ventricular hypertrophy and failure, aneurysm formation, and rupture, and is also a major contributor to atherosclerotic and small-vessel disease (23).…”

Section: Discussioncontrasting

confidence: 44%

Aortic Diameters and Calcifications in Former World-Class Cyclists

Maceira¹,

Santos‐Lozano

García-González³

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose: Concerns on whether athletes--particularly older ones--are at an increased risk of pathological aortic dilation exist, and the prevalence of aortic calcifications in these individuals is unknown. We aimed to compare the dimensions, distensibility, and prevalence of calcifications in the thoracic aorta between former male professional cyclists (cases) and sex/age-matched controls. Methods: We used a retrospective cohort design, where cases were former finishers of at least one Grand Tour (Tour de France, Giro d' Italia or Vuelta a España) and controls were untrained individuals with no previous sports history and free of cardiovascular risk. All participants underwent magnetic resonance and computer tomography assessments for the measurement of aortic dimensions and calcifications, respectively. Results: Cases showed larger (P < 0.05) dimensions than controls for aortic annulus, sinus, and arch, as well as for ascending and descending aorta. However, none of the participants presented with pathological aortic dilation (all diameters <40 mm). A slightly higher prevalence of calcifications in the ascending aorta was observed in cases (13% vs 0% in controls, P = 0.020). Subanalyses confirmed that cases who were still competing (masters category, n = 8) had larger aortic diameters (P < 0.05) and a greater presence of calcifications in the ascending/descending aorta (38% vs 0% for both segments, P = 0.032) than those who had become inactive (n = 15). No between-group differences were found for aortic distensibility. Conclusions: Former professional cyclists, particularly those who are still competing after retirement, show enlarged aortic diameters (albeit without exceeding upper limits of normality). Former professional cyclists also showed a slightly higher prevalence of calcifications in the ascending aorta than controls, although aortic distensibility was not compromised. The clinical relevance of these findings should be the subject of future studies.

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“…As noted above, a meta-analysis showed a small but statistically significant difference in aortic size between young athletes and controls, 9 and associations have been established between training duration and aortic size. 10 In addition, there is evidence of differences in aortic function, specifically aortic stiffness and aortic distensibility, between trained and untrained individuals, [33][34][35] and training interventions have been associated with improvements in distensibility and compliance. 36,37 Our findings expand the evidence of aortic remodeling and suggest that the aorta responds to the hemodynamic stress of endurance sport with a temporal trajectory that is slower than that of the myocardium.…”

Section: Discussionmentioning

confidence: 99%

Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes

et al. 2020

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IMPORTANCE Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling.OBJECTIVE To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019.EXPOSURES Long-term endurance exercise. MAIN OUTCOMES AND MEASURESThe primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable. RESULTS Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size. CONCLUSIONS AND RELEVANCEClinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.

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Aortic distensibility is increasing in elite athletes

Cited by 19 publications

References 14 publications

Effects of Angiotensin-Converting Enzyme Polymorphism on Aortic Elastic Parameters in Athletes

Effects of Angiotensin-Converting Enzyme Polymorphism on Aortic Elastic Parameters in Athletes

Aortic Diameters and Calcifications in Former World-Class Cyclists

Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes

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