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. 2020 May 1;5(5):522-531.
doi: 10.1001/jamacardio.2020.0054.

Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes

Timothy W Churchill  1   2 , Erich Groezinger  1 , Jonathan H Kim  3 , Garrett Loomer  1 , J Sawalla Guseh  1 , Meagan M Wasfy  1   2 , Eric M Isselbacher  2   4 , Gregory D Lewis  1 , Rory B Weiner  1   2 , Christian Schmied  5 , Aaron L Baggish  1   2
Affiliations

Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes

Timothy W Churchill et al. JAMA Cardiol. .

Abstract

Importance: Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling.

Objective: To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure.

Design, setting, and participants: This cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019.

Exposures: Long-term endurance exercise.

Main outcomes and measures: The primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable.

Results: Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size.

Conclusions and relevance: Clinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Baggish has received funding from the National Institutes of Health/National Heart, Lung, and Blood Institute; the National Football Players Association; and the American Heart Association to study the impact of exercise on cardiovascular structure and function and compensation for his role as team cardiologist from US Soccer, US Rowing, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Distribution of Aortic Sizes by Sport and by Sex
Distributions of aortic size at both the sinuses of Valsalva and the ascending aorta, measured leading edge–to–leading edge, are shown for men and women, with separate distributions presented for rowers and runners. Among men, 25% (66 of 267) measured 40 mm or larger at the sinuses of Valsalva and 18% (45 of 249) in the ascending aorta. Aortic sizes among rowers exhibited a rightward shift compared with that of runners (P < .01) in all cases except the ascending aorta in women, where the distribution was similar.
Figure 2.
Figure 2.. Actual vs Predicted Aortic Sizes by Sex and Sport
Measured aortic sizes are plotted by sport and sex against predicted sizes from existing population-level nomograms. Sinus of Valsalva dimensions are presented using leading edge–to–leading edge measurement, with predicted sizes from the body surface area–adjusted nomogram from Devereux et al. Ascending aortic predicted dimensions are derived from the nomogram from Saura and colleagues, who used a height-adjusted model using the inner edge–to–inner edge convention; dimensions are accordingly presented for inner edge–to–inner edge measurements for study individuals. In all cases, distribution of measured sizes exceeded that of predicted sizes (all P < .05).
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References

    1. Davies RR, Goldstein LJ, Coady MA, et al. . Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73(1):17-27. doi:10.1016/S0003-4975(01)03236-2 - DOI - PubMed
    1. Hiratzka LF, Bakris GL, Beckman JA, et al. ; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine . 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13):e266-e369. - PubMed
    1. Hagan PG, Nienaber CA, Isselbacher EM, et al. . The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897-903. doi:10.1001/jama.283.7.897 - DOI - PubMed
    1. Erbel R, Aboyans V, Boileau C, et al. ; ESC Committee for Practice Guidelines; The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) . 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J. 2014;35(41):2873-2926. doi:10.1093/eurheartj/ehu281 - DOI - PubMed
    1. Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation. 2005;111(6):816-828. doi:10.1161/01.CIR.0000154569.08857.7A - DOI - PubMed