Aortic Root Dimensions and Pulse Wave Velocity in Young Competitive Athletes

Tobias Engl,Renate Oberhoffer-Fritz,Patrick Fisel,Jan Müller

doi:10.3390/jcm10245922

Tobias Engl, Renate Oberhoffer-Fritz + Show 2 more

Open Access

https://doi.org/10.3390/jcm10245922

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Abstract

The assessment of aortic root dimensions is a cornerstone in cardiac pre-participation screening as dilation can result in severe cardiac events. Moreover, it can be a hint for an underlying connective tissue disease, which needs individualized sports counseling. This study examines the prevalence of aortic root dilatation in a cohort and its relationship to arterial stiffness as an early marker of cardiovascular risk due to vascular aging. From May 2012 to March 2018, we examined 281 young male athletes (14.7 ± 2.1 years) for their aortic root dimension. Moreover, we noninvasively assessed arterial stiffness parameter during pre-participation screening. Mean aortic diameter was 25.9 ± 3.1 mm and 18 of the 281 (6.4%) athletes had aortic root dilation without other clinical evidence of connective tissue disease. After adjusting for BSA, there was no association of aortic root diameter to pulse wave velocity (p = −0.054 r = 0.368) nor to central blood pressure (p = −0.029 r = 0.634). Thus, although a significant proportion of young athletes had aortic root dilatation, which certainly needs regular follow up, no correlation with arterial stiffness was found. It could be suggested that a dilated aortic root in young athletes does not alter pulse waveform and pulse reflection, and thus there is no increased cardiovascular risk in those subjects.

Highlights

The importance of pre-participation screening in athletes has increased in recent years, especially in children and adolescents, and in the junior squads, where it is considered a mandatory pre-requisite in many sports
There is no doubt that aortic dissection and rupture are the most serious complications of aortic root enlargement, it should be kept in mind that an enlarged aortic root may cause hemodynamic changes, especially with regard to the pulse wave pattern and central arterial compliance
Aortic root remodeling may change the pattern of the traveling pulse wave negatively to an earlier reflection of the backwards traveling wave, which imposes a greater afterload for the left ventricle resulting in remodeling and dysfunctional buffering [5,6]

Summary

Introduction

The importance of pre-participation screening in athletes has increased in recent years, especially in children and adolescents, and in the junior squads, where it is considered a mandatory pre-requisite in many sports. The main purpose of pre-participation screening is to check for pre-existing cardiac and great vessel disease and to assess the risk of developing cardiovascular events [1]. There is no doubt that aortic dissection and rupture are the most serious complications of aortic root enlargement, it should be kept in mind that an enlarged aortic root may cause hemodynamic changes, especially with regard to the pulse wave pattern and central arterial compliance. There is little knowledge on the prevalence of aortic remodeling in young athletes being still in their growth phase. This study investigates the prevalence of aortic root dilation in young athletes and the association with aortic compliance by means of pulse wave velocity and central blood pressure measurement

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