Aortic Root Size in Elite Athletes

It is known that sport-specific remodeling of the heart may occur with exercise. Although some overlap exists, exercise activity can be segregated into 2 forms: isotonic exercise (endurance training) and isometric exercise (strength training), with defining hemodynamic differences. Increased cardiac output leads to a volume challenge that occurs with isotonic exercise that affects all 4 heart chambers and may cause an increase in left ventricular (LV) mass, biventricular chamber dilation, biatrial enlargement, and enhanced diastolic function.1 Conversely, isometric exercise (strength training) will increase the peripheral vascular resistance and cause a pressure load on the heart. This results in concentric LV hypertrophy and reduction in LV diastolic function. Although an athlete may have expertise in one particular sport, usually elite athletes train with combined isotonic and isometric components (weight training, plyometrics, speed drills, running, etc.) and may not fit into one specific category of training.See Article by Boraita et al There is limited data on the effect of exercise training on the aorta and whether aortic dilation occurs because of the hemodynamic effects of chronic exercise training. One could hypothesize that with isometric exercise, there is a transient increase in peripheral vascular resistance and systolic hypertension that leads to increased aortic wall tension and chronically may result in aortic dilation. A meta-analysis performed by Iskandar and Thompson2 showed minor enlargement associated with training in elite athletes at the level of the aortic valve annulus and the sinus of Valsalva compared with controls. …