Clinical Investigation
Cardiovascular Findings in Athletes
Aortic Stiffness and Distensibility in Top-Level Athletes

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Background

Although cardiac adaptation to different sports has been extensively described, the potential relationship of training with aortic root (AR) elastic properties and diameters in top-level athletes remains not fully investigated. The aims of this study were to compare AR morphology and stiffness between highly trained athletes and sedentary subjects and to assess the independent determinants of AR stiffness and distensibility in athletes.

Methods

Four hundred ten elite athletes (220 endurance-trained athletes [ATE] and 190 strength-trained athletes [ATS]; 290 men; mean age, 28.3 ± 13.6 years; age range, 18–40 years) and 240 healthy controls underwent standardized comprehensive transthoracic echocardiography, including Doppler studies. End-diastolic AR diameters were measured at four locations: the aortic annulus, the sinuses of Valsalva, the sinotubular junction, and the maximal diameter of the proximal ascending aorta. The aortic distensibility index was calculated as 2 × (systolic proximal ascending aortic diameter − diastolic proximal ascending aortic diameter)/(diastolic proximal ascending aortic diameter) × (pulse pressure) (cm−2 · dyn−1 · 10−6). AR stiffness index was defined as (systolic blood pressure/diastolic blood pressure)/(systolic proximal ascending aortic diameter − diastolic proximal ascending aortic diameter)/diastolic proximal ascending aortic diameter. Analysis of variance was performed to evaluate differences among groups.

Results

Left ventricular (LV) mass index did not significantly differ between the two groups of athletes but was lower in controls. ATS showed higher body surface area, sum of wall thickness (septum plus LV posterior wall), and circumferential end-systolic stress, while LV stroke volume and LV end-diastolic volume were greater in ATE. AR diameters at all levels and AR stiffness were significantly greater in ATS than in ATE and controls, while AR distensibility was significantly higher in ATE. However, AR dilatation was observed only in four male power athletes (1%). By multivariate analyses, in the overall population of athletes, age, LV stroke volume, endurance training, and duration of training were the only independent determinant of higher AR distensibility. On the other hand, age, circumferential end-systolic stress, strength training, and duration of training were independently associated with AR stiffness in ATS.

Conclusions

AR diameters and stiffness were significantly greater in strength-trained athletes, while aortic distensibility was higher in endurance athletes compared with age- and sex-matched healthy controls.

Section snippets

Methods

From June 2008 to April 2010, 420 Caucasian elite athletes (mean age, 28.3 ± 13.6 years; age range, 18–40 years) and 240 healthy controls were referred to the Sports Medicine Ambulatory Service of Monaldi Hospital (Naples, Italy) for cardiovascular preparticipation screening9 and afterward to our echocardiographic laboratory for the purposes of the present study. Among these 420 athletes, 360 had been previously involved in our previous study of the effects of competitive sport training on

Results

Clinical characteristics of the study population are described in Table 1. The mean ages were comparable among the groups. In accordance with the effects of different training protocols, ATS at rest showed higher heart rates, BSAs, and SBPs than ATE.

ATS showed a higher sum of wall thickness (septum plus LV posterior wall), LV relative wall thicknesses, and ESSc, while LV end-diastolic volumes were greater in ATE. LV mass index and LV ejection fraction did not significantly differ between the

Discussion

Two-dimensional echocardiography is currently used to evaluate AR morphology and elasticity. Several authors have previously reported larger diameters of arterial and venous conductance vessels in athletes compared with sedentary individuals, even after normalization for BSA.6, 7, 20, 23 In the present study, first, we have confirmed that AR diameters are significantly greater in ATS compared with age-matched and sex-matched ATE, even if significant AR dilatation and aortic regurgitation proved

Conclusions

AR diameters and stiffness were significantly greater in ATS, while aortic distensibility was higher in ATE compared with age-matched and sex-matched healthy controls. In particular, the lower proximal aortic compliance observed in ATS was associated with higher resting brachial pulse pressures and higher indexes of LV afterload. The clinical implications of these findings with regard to cardiovascular risk warrant further investigation.

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