Athlete's artery: brachial vascular remodeling in elite athletes practicing different sporting disciplines

Abstract Introduction Exercise places physiological demands upon the cardiovascular system, subsequently leading to adaptations in structure and function. Different exercise modalities lead to distinct hemodynamic demands and, possibly, different patterns of adaptation. Purpose To evaluate influence of sporting discipline on brachial artery morphologic and functional parameters. Methods We studied 122 elite athletes (56% male) practicing different sporting disciplines that participated at 2023 Krakow European Games: 19 power (P), 30 skills (S), 50 endurance (E) and 22 mixed (M). Athletes were divided into two groups: Group 1 (G1) disciplines with active arm involvement during execution of specific discipline (canoeing, rowing, climbing, swimming, fencing) and Group 2 (G2) control group (cycling, beach soccer, karate, target shooting and skeet shooting). Brachial arterial diameter (BAD) was assessed using ultrasound. Arterial function was determined using flow mediated dilation (FMD) technique. Results G1 e G2 population were homogeneous in gender prevalence (p=0.435), age (p=0.176), BMI (p=0.349) and BSA (p=0.265). E athletes showed highest BAD (377.4 ± 89 mm) compared to other sporting disciplines (p=0.0005): vs. P (310.9 ± 77.7 mm, p=0.004); vs. S (318.6 ± 73.7 mm, p=0.003) and vs. M (309.9 ± 60.5 mm, p=0.002). No differences were highlighted between other comparison: P vs. S (p=0.726), P vs. M (p=0.963), S vs. M (p=0.659). Globally, G1 athletes presented significantly higher values of BAD (363.9 ± 81.2 mm vs. 308.3 ± 79.9 mm in G2, p=0.0005), prevalently due to significant differences in E athletes (BAD in G1: 407.4 ± 71.5 mm vs. 319.1 ± 90.8 mm in G2, p=0.0006). En fact, no differences in BAD were noted in other sporting disciplines: (P: G1 322.8 ± 84.1 mm vs. 287.1 ± 56 mm in G2, p=0.346; S: G1 325.6 ± 53 mm vs. 310.6 ± 91.1 mm in G2, p=0.592 and M: G1 314.2 ± 52.3 mm vs. 308.6 ± 62.6 mm in G2, p=0.865). No significant differences were observed in FMD between disciplines (p=0.269): E: 9.2 ± 9.6 %, P: 11.5 ± 11.6 %, S: 13.5 ± 10.9 % and M: 13.3 ± 10.9 %. Globally, no differences were noted in FMD% between G1 (11 ± 8.3%) and G2 (11.9 ± 13.1%), p=0.592. Further, similar values of FMD%. were found in sub-analysis for single sporting discipline: E G1 10 ± 6.4% vs. 7.6 ± 13.6% in G2, p=0.411; P G1: 12.4 ± 12.2% vs. 9.5 ± 9.9% in G2, p=0.610; S G1 12 ± 8.4% vs. 15.3 ± 12.9% in G2, p=0.412 and M G1 9.7 ± 3.6% vs. 14.4 ± 12.1% in G2, p=0.426. Conclusions Athlete’s artery is a vascular remodelling observed exclusively in endurance athletes, characterized by enlargement of brachial vessel diameter without affecting functional parameters, not seen in other disciplines. A further increase in diameter is observed in endurance athletes practicing disciplines with arms involvement. Endurance disciplines deeply affect cardiovascular system with distinct remodelling also in vascular morphology, in proportion to the use of the specific vascular district.