Aortic Root Size and Prevalence of Aortic Regurgitation in Elite Strength Trained Athletes

doi:10.1016/j.amjcard.2007.02.108

The American Journal of Cardiology

Volume 100, Issue 3, 1 August 2007, Pages 528-530

https://doi.org/10.1016/j.amjcard.2007.02.108 Get rights and content

Athletes involved in mainly static or isometric exercise (e.g., weight lifting, power lifting, and bodybuilding) develop pressure overloads due to the high systemic arterial pressure found in this type of exercise. It is hypothesized that chronically elevated aortic wall tension in strength-trained athletes is associated with aortic dilatation and regurgitation. The aim of this study was to evaluate aortic root size and the prevalence of aortic regurgitation in elite strength-trained athletes. The cohort included 100 male athletes (mean age 22.1 ± 3.6 years; all were finalists or medalists in the country) and 128 healthy age- and height-matched subjects (the control group). Aortic root diameters at end-diastole were measured at 4 locations: (1) the aortic annulus, (2) the sinuses of Valsalva, (3) the sinotubular junction, and (4) the maximal diameter of the proximal ascending aorta. Aortic root diameters at all levels were significantly greater in the strength-trained athletes (p <0.05 for all comparisons). When the strength-trained athletes were divided into quartiles of duration of high-intensity strength training (first quartile: <18 months; second quartile: >18 and <36 months; third quartile: >36 and <54 months; fourth quartile: >54 months), progressive enlargement was found at all aortic diameters. In conclusion, aortic root diameters in all segments of the aortic root were significantly greater in elite strength-trained athletes compared with an age- and height-matched population.

Section snippets

Methods and Results

Professional strength-trained athletes referred to the Institute of Sports Science from 2001 to 2005 were enrolled in this study. Subjects with Marfan’s syndrome (n = 1), Ehlers-Danlos syndrome, and bicuspid aortic valves (n = 2) were excluded from the study. The cohort included 100 consecutive male athletes (mean age 22.1 ± 3.6 years; all were finalists or medalists in the country). Previous studies have suggested that height is the most important determinant of aortic root size compared with

Discussion

To the best of our knowledge, there is no published report regarding strength training–induced dimensional adaptations of the aortic root. The significant observation in this study is the impact of strength training on the dimension of the aortic root. In the present study, using an accurate measurement of the entire aortic root, we showed significant increase in aortic root size in elite strength-trained athletes compared with the values predicted for age- and height-matched controls.

References (23)

M.J. Roman et al.
Prognostic significance of aortic root dilation in the Marfan syndrome
J Am Coll Cardiol
(1993)
R.T. Hahn et al.
Association of aortic dilation with regurgitant, stenotic, and functionally normal bicuspid aortic valves
J Am Coll Cardiol
(1992)
R.G. Carlson et al.
Cystic medial necrosis of the ascending aorta in relation to age and hypertension
Am J Cardiol
(1970)
T.J. Schlatmann et al.
Pathogenesis of dissecting aneurysm of the aorta: comparative histopathologic study of significance of medial changes
Am J Cardiol
(1977)
C.M. Reed et al.
Aortic dimensions in tall men and women
Am J Cardiol
(1993)
S.M. Nidorf et al.
New perspectives in the assessment of cardiac chamber dimensions during development and adulthood
J Am Coll Cardiol
(1992)
M.J. Roman et al.
Two-dimensional echocardiographic aortic root dimensions in normal children and adults
Am J Cardiol
(1989)
M. Ciobanu et al.
Pulsed Doppler echocardiography in the diagnosis and estimation of severity of aortic insufficiency
Am J Cardiol
(1982)
G.J. Perry et al.
Evaluation of aortic insufficiency by Doppler color flow mapping
J Am Coll Cardiol
(1987)
B.F. Waller et al.
Severe aortic regurgitation from systemic hypertension (without aortic dissection) requiring aortic valve replacement: analysis of four patients
Am J Cardiol
(1982)

J.D. Seder et al.

Prevalence of aortic regurgitation by color flow Doppler in relation to aortic root size

J Am Soc Echocardiogr

(1990)

Cited by (63)

Aortic root/left ventricular diameters golden ratio in competitive athletes
2023, International Journal of Cardiology
The athlete's heart is a well-known phenomenon characterized by a harmonic remodelling that affects the cardiac chambers. However, whether mild-to-moderate aortic dilatation can be considered normal in athletes is debated. This study aimed to evaluate the ratio between left ventricular (LV) size and aortic dimensions, reporting the normal values of the ratio between the aortic root diameters at the level of the sinuses of Valsalva and LV diameters (AoD/LVEDD ratio) in a wide cohort of competitive athletes.
Competitive athletes were compared with sedentary subjects and patients with aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26 ± 7 years), 410 sedentary (74.1% males, mean age 29 ± 11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56 ± 7 years).
Patients with aortic dilatation had both an absolute (39.2 ± 2.4 mm) and indexed (19.4 ± 2.2 mm/m2) aortic diameter larger than athletes (30.6 ± 3.2 mm; 16.1 ± 1.5 mm/m², p < 0.05) and sedentary subjects (30.5 ± 3.1 mm; 16.5 ± 1.6 mm/m², p < 0.05), with no differences between athletes and sedentary subjects. The AoD/LVEDD ratio was lower in athletes (0.59 ± 0.06) compared to controls (0.65 ± 0.05, p < 0.05) and patients with aortic dilatation (0.81 ± 0.06, p < 0.05). The patients with aortopathy had the lowest LVEDD/AoD ratio, while competitive athletes had the highest, with values of 1.71 ± 0.16 in the latter (overall p value<0.001).
In this study, we reported the AoD/LVEDD and LVEDD/AoD ratio values in a cohort of healthy athletes, additional parameters that could help confirm the harmonic remodelling in the athlete's heart.
Sports Participation and Physical Activity in Individuals with Heritable Thoracic Aortic Disease and Aortopathy Conditions
2022, Clinics in Sports Medicine
Aortic Root Dilation and Testosterone Use: Are They Associated?
2020, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
Two studies stand out, with substantial evidence supporting a relationship between testosterone and aortic dilation. The first and most recent, by Lu et al.2 from 2007, studied 48 male Sprague-Dawley rats. The researchers found that testosterone can cause acute vasorelaxation and can modulate smooth muscle cells via K+ channels in the rat thoracic aorta, demonstrating the acute effects of testosterone.
Aortic root dilation and thoracic aortic aneurysms are relatively rare in young and healthy patient populations. However, a number of observed incidental cases regarding young males and testosterone use raises suspicion of a potential risk factor for aortic root dilation. The authors’ patient, a healthy 40-year-old man with a significant history of testosterone use who developed a massively dilated aortic root, is sufficiently alarming to report. Notwithstanding anecdotal cases, there exists a well-known association between elite strength athletes and aortic root dilation. Nevertheless, very little clinical research exists on the relationship between testosterone use and aortic root dilation and/or thoracic aortic aneurysms. Furthermore, a small number of animal studies showed a relationship between testosterone and vascular dilation, particularly the aorta. Although testosterone may play a role in the development of aortic pathologies, further research is necessary to clarify the possible relationship if cases such as these are to be prevented.
Comparable conditioned pain modulation and augmented blood pressure responses to cold pressor test among resistance exercisers compared to healthy controls
2020, Biological Psychology
Conditioned pain modulation (CPM) test examines central pain inhibitory processing. Aerobically-trained individuals show greater CPM. However, there is a paucity of knowledge regarding CPM among resistance exercise-trained individuals, although regular engagement in resistance exercise may lead to greater CPM via augmented blood pressure (BP) responses during the CPM test. Therefore, the present study compared CPM and BP responses between resistance exercisers (REs) and controls (n = 15 per group). The participants completed the CPM test to evaluate changes in electrical pain ratings to the ankle after cold pressor test (CPT) consisting of immersing a hand into a cold water bath compared to baseline. REs and controls exhibited similar CPM, although REs showed greater systolic BP responses to CPT compared to controls. The results suggest that the role of BP in CPM is likely complex, and the role of exercise in central pain processing and cardiovascular system needs to be studied.
Rugby Player's Aorta: Alarming Prevalence of Ascending Aortic Dilatation and Effacement in Elite Rugby Players Rugby Player's Aorta
2020, Heart Lung and Circulation
Citation Excerpt :
Our study was not powered to identify susceptible rugby positions, however the first row of the scrum are subjected to the most extreme isometric forces and may be particularly at risk. Whilst the relative effects of strength or endurance sports on the aorta is contested, there are now several studies suggesting strength or power sports enlarge aortas slightly more, at the time of competition [14,21,22]. Such aortic dilatation was progressive and correlated with longer duration of training in 100 elite wrestlers, compared with a control group [22], but still did not exceed a mean aortic root size of 35 mm in the subgroup who had trained for the longest period.
Prompted by a cluster of observations concerning ascending aortic pathology in elite rugby players, we assessed over 150 asymptomatic predominantly retired players with echocardiography, aiming to document the prevalence and severity of ascending aortic dilatation and/or anterior aortic effacement, both ‘risk factors’ for potentially catastrophic aortic complications.
Rugby players (at least 5 years of high level competitive rugby) were classified as elite (national, state or first grade representatives) or non-elite. A total of 152 asymptomatic players with a mean age of 45 ± 13 years (range 21–65) underwent transthoracic echocardiography. Z-scores (number of standard deviations from a population mean) were calculated for aortic root and ascending aortic size.
Regarding the aortic root, a Z-score of >2 was seen in 24% (expected prevalence 2.3%, p < 0.001) and a Z-score >3 was seen in 4% (expected prevalence 0..1%, p < 0.001). Sixty-two (62) players (41%) had an aortic root greater than 40 mm diameter. Ascending aortic Z-scores were >2 in 53% of players and >3 in 22% (p < 0.001). Abnormal anterior aortic effacement at the sinotubular junction (STJ) was seen in 88 players (58%). Abnormal aortic dilatation and effacement were associated with a longer duration of competitive rugby participation and elite status, respectively.
Ascending aortic dilatation with abnormal anterior effacement is exceedingly common in asymptomatic retired elite rugby players. This warrants increased surveillance in retired players until the clinical significance of these findings can be further investigated.
Noninvasive predictors of cardiac arrhythmias in bodybuilders
2018, Revista Portuguesa de Cardiologia
Arrhythmias are often recorded in strength training athletes without cardiovascular abnormalities but may also be a sign of an underlying cardiovascular disease which carries a risk of sudden cardiac death (SCD). Nowadays, bodybuilding is a popular sport among adolescents and young adults. There have been few studies of arrhythmias comparing bodybuilders with healthy controls and excluding anabolic steroid use. We aimed to assess the structural, functional and electrical characteristics of bodybuilders’ hearts compared with control subjects.
In this study, we assessed 35 male competitive bodybuilders and 35 healthy control subjects matched for age, gender, and body mass index. A detailed cardiovascular and systemic examination was performed at the beginning of the study to collect demographic data and anthropometric measures. Biochemical and hematologic, echocardiographic, 24-h Holter, and ECG measurements were obtained from all participants.
Ventricular arrhythmias were encountered significantly more frequently in bodybuilders than in the control group. QT and QTc were not significantly different between groups. Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were significantly greater in bodybuilders than in the control group (p<0.001 for all). There was a positive correlation between Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio and right ventricular (RV) diameter and arrhythmias.
Prolonged repolarization is common in athletes, although its predictive value is unclear. In this study, alterations in ventricular repolarization were positively correlated with RV dimensions. Therefore, we postulate that arrhythmias in strength athletes may be predicted by assessing the right ventricle echocardiographically and dispersions of repolarization on the ECG, and that SCD could be avoided in strength athletes by careful application of this information.
As arritmias são registadas muitas vezes nos atletas de alta competição sem alterações cardiovasculares, podendo no entanto ser um sinal de doença cardiovascular subjacente, o que constitui um prognóstico de risco de morte súbita cardíaca (MSC). Hoje em dia o fisiculturismo é um desporto popular praticado por muitos adolescentes e adultos jovens. Não são muitos os estudos comparativos entre os fisiculturistas e grupos de controlo saudáveis. Foi nosso objetivo avaliar as características estruturais, funcionais e elétricas do coração dos fisiculturistas comparadas com as do grupo controlo.
Neste estudo avaliámos 35 fisiculturistas de competição do sexo masculino e 35 indivíduos saudáveis do grupo controlo, emparelhados por idade, género e índice de massa corporal. Foram realizados exames cardiovasculares e sistémicos no início do estudo, com registo de dados demográficos e medidas antropométricas. Foram obtidos registos bioquímicos e hematológicos, ecocardiográficos e do registo de Holter de 24 horas, bem como medições eletrocardiográficas de todos os participantes.
As arritmias ventriculares encontradas foram significativamente mais frequentes nos fisiculturistas do que no grupo controlo. Os valores do QT e do QTc não foram significativamente diferentes entre os grupos. O intervalo Tp-e, a relação TP-e/QT e a relação Tp-e/QTc foram significativamente superiores no grupo dos fisiculturistas quando comparado com o grupo controlo (p<0,001). Verificou-se uma correlação positiva entre o intervalo Tp-e, a relação Tp-e/QT e a relação Tp-e/QT com o diâmetro do ventrículo direito (VD) e a arritmia.
A repolarização prolongada é comum nos atletas, mesmo quando o seu valor preditivo é pouco claro. Neste estudo, as alterações na repolarização ventricular foram positivamente correlacionadas com as dimensões do VD. Assim, admitimos que as arritmias nos atletas de alta competição possam ser previsíveis através de ecocardiografia do VD e por dispersões da repolarização no ECG. Por último, a MSC pode ser evitável nos atletas de alta competição com recurso a este tipo de interpretação, considerada razoável e passível de aplicação.

View all citing articles on Scopus

View full text

MiscellaneousAortic Root Size and Prevalence of Aortic Regurgitation in Elite Strength Trained Athletes

Section snippets

Methods and Results

Discussion

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Soc Echocardiogr

Miscellaneous
Aortic Root Size and Prevalence of Aortic Regurgitation in Elite Strength Trained Athletes