Prevalence and determinants of thoracic aortic dilatation detected by focused cardiac ultrasound in recreational and competitive sports participants

Objectives Ascending aortic dilation is a clinically important cardiovascular condition, yet its prevalence and associated factors in recreational athletes remain poorly described. This study aimed to determine the prevalence and predictors using an aorta-focused echocardiographic protocol (FoCUS) performed by non-expert operators. Design Retrospective cross-sectional observational study. Methods 400 participants (79% men; median age 45 years; range 11–78; 65% recreationally active individuals) undergoing routine sports cardiology screening were included. Aortic root and tubular diameters were measured using FoCUS by trained sports physicians. Cardiovascular risk factors and sports exposure were recorded. Agreement between FoCUS and transthoracic echocardiography (TTE) performed by cardiologists was assessed in participants undergoing both examinations. Multivariate logistic regression identified independent predictors of aortic dilation. Results Thoracic aortic dilatation was detected in 45 participants (11.3%), 42 of whom were aged ≥35 years. Among cases, 62.2% had isolated aortic root dilation, 15.6% isolated tubular dilation, and 22.2% combined dilation. Prevalence did not differ by sex (p = 0.32). Hypertension was independently associated with aortic dilation (OR 3.15; 95% CI 1.2–8.3; p < 0.001), together with years of regular sports practice (OR 1.06 per year; 95% CI 1.03–1.10; p = 0.021). FoCUS showed good agreement with TTE (n = 59; CCC 0.948 for the aortic root and 0.93 for the tubular aorta), with minimal bias (−0.01 mm and + 0.05 mm, respectively). Conclusions Ascending aortic dilation was a relatively frequent finding in our cohort, particularly among participants aged ≥35 years. Hypertension and years of regular sports practice were independently associated with aortic dilatation. An aorta-focused echo protocol performed by trained non-experts is accurate and may support routine cardiovascular screening.