A Meta-Analysis of Aortic Root Size in Elite Athletes
Background—The aorta is exposed to hemodynamic stress during exercise, but whether or not the aorta is larger in athletes is not clear. We performed a systematic literature review and meta-analysis to examine if athletes demonstrate increased aortic root dimensions when compared to non-athlete controls.
Methods and Results—We searched MEDLINE and Scopus from inception through August 12th 2012 for English-language studies reporting the aortic root size in elite athletes. Two investigators independently extracted athlete and study characteristics. A multivariate linear mixed model was used to conduct meta-regression analyses. We identified 71 studies reporting aortic root dimensions in 8564 unique athletes, but only 23 of these studies met our criteria by reporting aortic root dimensions at the aortic valve annulus or sinus of Valsalva in elite athletes (n=5580). Athletes were directly compared to controls (n = 727) in 13 studies. Upon meta-regression, the weighted mean aortic root diameter measured at the sinuses of Valsalva was 3.2 mm (p = 0.02) larger in athletes than in the non-athletic controls , whereas aortic root size at the aortic valve annulus was 1.6 mm (p= 0.04) greater in athletes than controls.
Conclusions—Elite athletes have a small but significantly larger aortic root diameter at the sinuses of Valsalva and aortic valve annulus, but this difference is minor and clinically insignificant. Clinicians evaluating athletes should know, that marked aortic root dilatation likely represents a pathological process and not a physiological adaptation to exercise.
- Received August 15, 2012.
- Accepted January 4, 2013.
- Copyright © 2013, Circulation