SPREAD multicentre study: sports practice and its effect on bicuspid aortic valve disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Bicuspid aortic valve (BAV) is the most common congenital cardiac condition among the general population and competitive athletes. BAV could be associated with progressive aortic dilatation, stenosis and/or regurgitation. There are concerns about the possible detrimental effects of exercise training on aortic size and valve function due to the hemodynamic stress on the aorta during exercise. However, data in the literature are scarce and sometimes discordant. Objectives This multicenter study aimed to analyze the influence of sport on aortic size and valve function in BAV patients. Methods Three groups were analyzed: competitive athletes with BAV, athletes with tricuspid aortic valve (TAV) and sedentary controls with BAV, age- and sex-matched. We assessed the morphology and degree of aortic valve stenosis, regurgitation, aortic dimension, and left ventricular (LV) characteristics by 2D echocardiography. Individuals with moderate-severe stenosis and regurgitation or relevant aortic dilation (> 45 mm (men) or >41 mm (women) were excluded from the study. Results The study population was composed of 500 subjects:184 BAV athletes (84% males; mean age 30±11 years), 191 TAV athletes (82% males; mean age 30±11 years), 125 BAV sedentary controls (82% males; mean age 34±10 years). The aortic annulus was greater in BAV athletes (25.0±3.6 mm) than in TAV athletes (21.7±2.9 mm) and BAV controls (23.9±3.6 mm), p<0.005. Sinuses of Valsalva, sinotubular junction and ascending aorta diameters were smaller in TAV athletes than in BAV subjects (<0.005), but there were no significant differences between BAV athletes and BAV controls. LV index volumes and mass were greater in BAV athletes than in the other two groups (p<0.005). Moreover, BAV athletes showed higher gradients than sedentary controls (p<0.005). Conclusions This multicenter study demonstrated that athletes with BAV have larger aortic diameters than athletes with TAV. However, no differences between BAV athletes and sedentary controls were observed, suggesting that exercise training does not significantly affect aortic dilation, with the exception of aortic annulus. Conversely, sports practice negatively influenced valve function in BAV athletes. Valvular dysfunction seems to affect the LV geometry, with a trend for being more dilated and hypertrophic in BAV athletes than in the other groups.