Focused echocardiographic screening of the aortic valve and aorta in elite rugby players

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Grant from the charitable organisation Cardiac Risk in the Young. Background Pre-participation cardiac screening (PPS) of professional rugby players in the United Kingdom consists of an ECG-based evaluation. However, structural abnormalities that would not manifest on an ECG, such as aortic dilatation might be underdiagnosed and aortic dissection has previously been identified as a cause of sudden cardiac death in athletes (1). Purpose To trial focused transthoracic echocardiography (FTTE) screening for aortopathy as part of PPS and to determine normative aortic root measurements in rugby players, comparing dimensions with sedentary controls. Methods Professional male rugby players undergoing PPS were consented to have an FTTE performed as part of their cardiac evaluation. The aortic valve was visualised in the parasternal long and short axis views to delineate valve morphology. Aortic root measurements were taken at the sinus of Valsalva (SOV), sinotubular junction (STJ) and ascending aorta (AA) at end-diastole, from inner edge to inner edge. All measurements were indexed to the individuals height (in metres). Dilatation was defined as a dimension of >40mm at any aortic level. The findings were compared with a control population of sedentary age, and height-matched volunteers (defined as <2 hours physical activity per week) recruited from a national screening programme offered by the charitable organisation Cardiac Risk in the Young (CRY). Results 131 rugby players were screened, mean age 20.5years and on average engaged in 16 hours of mixed aerobic and strength-based training per week. 187 age-and-height-matched sedentary controls were included. Overall, rugby players had a significantly larger aortic root at all levels measured, compared with controls (Table 1). The only exception was the indexed ascending aorta dimensions. 2 rugby players had aortic dimensions >40mm at the SOV compared with no controls. A bicuspid aortic valve (BAV) was identified in 1 in one rugby player and 2 controls. These were excluded from the comparison of aortic dimensions due to the likelihood of them having an associated aortopathy. Conclusion Incorporating FTTE as part of existing PPS algorithms is an inexpensive way of screening for aortopathy and BAV. Identifying abnormalities may enable individuals to be suitably followed-up. Elite rugby players have a larger aortic root than sedentary controls. The significance of this requires corroboration in larger-scale, longitudinal studies.