Indexing aortic dimensions for BSA reduced aortic dilatation prevalence from 11% to 3.5% in elite athletes; endurance athletes had significantly larger indexed aortic sizes (p<0.001).
Does BSA indexation affect the classification of aortic dilatation in elite athletes compared to absolute measurements?
Indexing aortic dimensions for body surface area significantly reduces the overestimation of aortic dilatation in elite athletes, while endurance training is associated with larger indexed aortic dimensions.
Absolute Event Rate: 0% vs 0%
Abstract Background Aortic dilatation in athletes is rare, and its association with different sports and the sports-related anthropometrics remain unclear. Furthermore, most studies assessing aortic dimensions have used transthoracic echocardiography (TTE), which lacks the accuracy of cardiac magnetic resonance (CMR). Purpose To determine the prevalence of aortic dilatation and to assess the impact of Body Surface Areas (BSA) indexation on reclassification, stratified by endurance and non-endurance sports categories. Methods Cross-sectional study in elite athletes without a history of cardiovascular disease, who underwent pre-participation CMR screening. Aortic dimensions were measured at: sinus of Valsalva, sinotubular (ST) junction, and descending aorta. Aortic dilatation was defined as ≥38 mm in females and ≥40 mm in males. Prevalence was compared before and after BSA indexation using Welch’s t-test, Pearson’s Chi-squared test, and Wilcoxon rank sum test, as appropriate. We classified athletes as endurance or non-endurance based on ESC sports categories. Results In 312 elite athletes (133 female, 43%), mean age was 25.6 ± 5 years. Mean aortic dimensions (female vs. male): sinus of Valsalva 30.1 ± 3.8 vs. 34.7 ± 4.2 mm, ST-junction 25.8 ± 2.5 vs. 28.7 ± 3.2 mm, descending aorta 17.7 ± 1.8 vs. 20.4 ± 2.5 mm. Using absolute measurements, 35 athletes (11%) had at least one aortic segment classified as dilated, the majority (n=30) sinus of Valsalva. After BSA indexation, this number decreased to 11 (3.5%). Eight athletes were reclassified from having normal aortic segments to having at least one dilated segment. One athlete had persistent ST junction dilatation, and 6 had dilated descending aorta (no BSA indexation applied). Endurance athletes (n=142) had greater indexed aortic dimensions than non-endurance athletes (n=170) at all levels: sinus of Valsalva 17.6 ± 2.0 vs. 16.5 ± 2.4 mm (p0.001), ST-junction 14.7 ± 1.7 vs. 13.9 ± 1.4 mm (p0.001), descending aorta 10.3 ± 1.1 vs. 9.7 ± 1.2 mm (p0.001). Sports classification in the cohort resulted in 17 endurance and 18 non-endurance athletes with dilated aortic measurements in any segment (p0.005), decreasing to 15 and 4 after indexation (p0.005). Aortic size correlated with LVEDVi/BSA in both groups in all segments (R = 0.19- 0.26, p0.05). Conclusion Indexing aortic dimensions for BSA reduced the prevalence of aortic dilatation in elite athletes, demonstrating its impact on classification. However, it also led to reclassification from normal to dilated in eight athletes. Endurance training was associated with larger aortic dimensions and greater ventricular volumes. This CMR elite athlete study demonstrates the importance of including anthropometrics in the analysis of aortic dimensions in athletes, both to ensure accurate classification and prevent over- and underestimation of aortic dilatation in elite athletes.Table 1.Population characteristics
Hri et al. (Sat,) reported a other. Indexing aortic dimensions for BSA reduced aortic dilatation prevalence from 11% to 3.5% in elite athletes; endurance athletes had significantly larger indexed aortic sizes (p<0.001).