Prevalence and progression of aortic root dilatation in highly trained young athletes

Objectives Aortic root dilatationis reported in young athletes; however, it is unclear whether such remodelling is physiological or, whether it represents a potential aortopathy. This observational study investigated the prevalence and progression of aortic root dilatationin young athletescompeting at regional or national level. Methods Between 2003 and 2015, 3781 athletesaged 19±5.9 years (63.3% male) underwent echocardiography as part of a cardiac screening programme to identify athleteswith structural abnormalities. Athletes trainedfor an average of 16.7 hours per week. Aortic diameterwas measured at the level of sinuses of Valsalva. Results were compared with 806 controls. Athleteswith an enlargedaortic diameterwere followed up for 5±1.5 years. Results Athletesrevealed a larger mean aortic diametercompared with controls (28.3±4.1 vs 27.8±4.1 mm; p=0.01). The 99th percentile value for aortic diameterin the athletecohort was defined as the upper limit and was 40 mm in males and 38 mm in females. The aortic diametermeasured >40 mm in five male (0.17%) (40–43 mm) and >38 mm in six female (0.4%) (39–41 mm) athletes. During follow-up, none of the athleteswith an enlargedaortic diametershowed progressive aortic enlargementcompared with the first assessment (40.6±0.9 vs 40.5±0.7 mm in males; (p=0.111) and 38.3±0.6 vs 38.0±0.7 mm in females; (p=0.275)). Conclusions A small minority (0.3%) of athletesreveal an enlargedaortic diameter. Medium-term follow-up does not reveal progressive enlargementof the aortic diameterindicative of aortopathy. Longer surveillance studies are necessary to elucidate the precise significance of an enlargedaortic diameterin athletes.