Aortic Root Diameter in Highly-Trained Competitive Athletes: Reference Values According to Sport and Prevalence of Aortic Enlargement

Background: Studies exploring the extent of aortic root dilation across the different types of sport are limited. We aimed to define the physiological limits of aortic remodelling in a large population of healthy elite athletes in comparison with nonathletic controls.Methods: A total of 1995 consecutive athletes evaluated at the Institute of Sports Medicine (Rome, Italy) and 515 healthy controls underwent a comprehensive cardiovascular screening. The aortic diameter was measured at the level of the sinuses of Valsalva. The 99th percentile from the mean of the aortic diameter in the control population was used to define an abnormally enlarged aortic root dimension.Results: Athletes showed a larger aortic root diameter (30.6 [& PLUSMN; 3.3] vs 28.1 [& PLUSMN; 3.1] mm, P value < 0.001) than controls. The difference was evident in male and female athletes, regardless of sport-predominant component and level of intensity. The 99th percentile value for aortic root diameter in control male and female subjects was 37 mm and 32 mm, respectively. Based on these values, 50 (4.2%) male and 21 (2.6%) female athletes would have been diagnosed with an enlarged aortic root. However, aortic root diameter of clinical relevance-ie, > 40 mm -was observed in only 17 male athletes (0.85%) and did not exceed > 44 mm.Conclusions: Athletes show a mild, although significant, increased aortic dimension in comparison with healthy controls. The degree of aortic enlargement varies in relation to type of sports and sex. Even-tually, only a small minority of athletes exhibited a markedly enlarged aortic diameter (ie, > 40 mm) in a range of clinical relevance.