High prevalence of aortic dilatation in former elite rowers: results from the ELITE-ROW study

Introduction Elite rowers are exposed to distinct hemodynamic loading conditions characterized by repetitive surges in stroke volume and cardiac output, marked systolic blood pressure elevations, and substantial pulsatile afterload. This combination of high dynamic and high static components promotes exercise-induced cardiac remodelling (EICR). While cardiac adaptations to chronic hemodynamic loading have been well described, data on concomitant aortic remodelling remain limited, particularly in older athletes with prolonged lifetime exposure. Purpose To determine the prevalence of thoracic aortic dilatation in former elite rowers ≥40 years, assessed by transthoracic echocardiography (TTE). Methods We included former elite (national, international, or Olympic) Dutch rowers aged ≥40 years with ≥10 years of competitive rowing. We excluded athletes with a known heritable connective tissue disorder linked to thoracic aortic disease. All subjects underwent a cardiovascular examination, including ECG, blood pressure measurement, laboratory testing, and TTE to assess aortic dimensions at the root (measured at the sinus of Valsalva), sinotubular junction, and ascending aorta. Aortic dilatation was defined as having ≥1 measurement above the sex-specific ESC cut-offs (men/women), i.e. aortic root >40/34 mm, sinotubular junction >38/33 mm, and ascending aorta >40/36 mm. Results We included 87 former elite rowers (29% women, median age 67 years) with training exposure of 40 [18–50] years. European, World, and Olympic Championship participation was reported by 30 (34%), 73 (84%), and 43 (49%) rowers, respectively. Mean systolic and diastolic blood pressure was 137 mmHg 83 mmHg. In men, mean aortic diameters were: root 39.7 ± 3.5 mm, sinotubular junction 33.1 ± 4.3 mm, and ascending aorta 38.3 ± 3.9 mm. Corresponding values in women were 33.8 ± 4.2 mm, 29.3 ± 4.1 mm, and 34.8 ± 4.4 mm, respectively. Aortic dilatation was present in 49% (43/87) of rowers: men 48% and women 52%. Dilatation involved one segment in 22 athletes, two segments in 18, and all three segments in three. Years of top-level rowing were significantly higher in women with aortic dilatation than in those without dilatation (8.5 ± 3.4 vs. 5.7 ± 3.0 years, p = 0.04). Conclusion In former elite rowers aged ≥40 years, aortic dilatation is found in approximately half – a prevalence substantially higher than reported in the general population. However, whether former rowers are at high risk of an acute aortic syndrome or dissection remains unknown. Functional and tissue characteristic aorta studies, next to longitudinal follow-up, are needed to determine whether aortic dilatation in former rowers is associated with detrimental health outcomes, and to evaluate whether current aortic diameter-based guideline sports restrictions are justified in this population.