Key result
Elite athletes show ~1.7 mm larger absolute AoSV than controls, but no difference when BSA-indexed.
Why the study?
To assess the presence and extent of aortic remodelling in elite athletes compared with non-athlete healthy controls.
Does elite athletic training increase aortic diameters at the sinus of Valsalva compared to non-athlete healthy controls?
Meta-Analysis (n=12,101)
Does elite athletic training increase aortic diameters at the sinus of Valsalva compared to non-athlete healthy controls?
Aortic dimensions at the sinus of Valsalva are mildly larger in elite athletes in absolute terms, but not when properly indexed to body surface area, highlighting the importance of proper normalization to avoid misdiagnosing aortopathies.
Answers are grounded in this paper and cite their sources.
Indexing to BSA prevents overdiagnosis of aortopathy in athletes; confirms necessity of body-size adjustment in assessment and trials.
Aims To assess the presence and the extent of an ‘aortic remodelling’ in elite athletes. Methods and results A systematic review and meta-analysis of literature were conducted for studies (1981–2024) reporting echocardiographic aortic diameters of elite athletes compared with non-athlete healthy controls. Among the 5494 studies retrieved, 21 (9464 elite athletes vs. 2637 non-athlete controls) fulfilled all eligibility criteria. Data were aggregated using a random-effects model for estimating the pooled risk ratio and mean difference (MD). Absolute aortic diameters at the sinus of Valsalva (AoSV) were higher in overall elite athletes compared with non-athlete healthy controls {MD 1.69 [95% confidence interval (CI) 1.01–2.37] mm; P < 0.001} and if stratified to sex. This difference was maintained if AoSV was indexed to height (AoSV/h) [MD 0.04 (95% CI −0.00–0.08) mm/m; effect size 2.18 (95% CI 1.10–3.26); P < 0.001]. The analysis of AoSV/h according to sex was not performed for the paucity of studies. However, when indexed to body surface area (AoSV/BSA), no differences were found between the two groups [MD 0.04 (95% CI −0.25–0.34) mm/m2; P = 0.880], also according to sex. Above findings were not influenced by age. Conclusion Absolute AoSV was mildly larger in athletes compared with non-athlete healthy controls, even when indexed to height. However, no differences were evident when indexed by BSA, irrespective of sex, type of sport, and age. Therefore, assessment of the aortic size in elite athletes should consider the proper normalization in order to avoid misdiagnosis of aortopathies. Registration PROSPERO: CRD42024561255 Lay summary Aortic diameters evaluation in athletes represents an important topic in cardiology and the knowledge about the aortic remodelling driven by intense exercise would allow for the correct management of athletes by differentiating those with pathologic enlargement from those with physiologic adaptation. This comprehensive meta-analysis highlights mildly larger absolute aortic diameters at the sinus of Valsalva diameters in elite athletes compared with non-athlete healthy controls, even when indexed to height. However, no differences were evident when indexed by body surface area, irrespective of sex, type of sport, and age.Assessment of the aortic size in elite athletes should consider the proper normalization in order to avoid misdiagnosis of aortopathies.
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Carbone et al. (2024) conducted a meta-analysis in Aortic remodelling in elite athletes (n=12,101). Elite athletic training vs. Non-athlete healthy controls was evaluated on Absolute aortic diameters at the sinus of Valsalva (AoSV) (MD 1.69 mm, 95% CI 1.01-2.37, p=<0.001). Elite athletes had mildly larger absolute aortic diameters at the sinus of Valsalva compared with non-athlete controls (MD 1.69 mm; 95% CI 1.01-2.37; P<0.001), but no difference when indexed to BSA.
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