LAUSR

The primary goal of pre-participation cardiac evaluation in athletes is to identify individuals at high risk of sudden death but other cardiac abnormalities may be discovered.  Athletes tend to have larger aortic dimensions than sedentary controls however it is unclear if this represents an aortopathy or is a normal physiological response to physical conditioning. To better understand the clinical implications of an enlarged aortic root in young athletes, Gati and colleagues1 compared aortic size and clinical outcomes in 3781 athletes with no evidence of a genetic aortopathy (mean age 19 years, 63% male) to 806 control subjects. This study found an enlarged aortic diameter in only 0.3% of athletes with no evidence of progressive enlargement over 5 years of follow-up. (figure 1) Figure 1 Absolute aortic root dimensions in athletes and controls. In an editorial, Jorstad and Groenink2 concur with the author’s conclusion that there appears to be little effect of physical activity on aortic size in young athletes without an underlying connective tissue disorder. The two other points they emphasise are that1 (1) reproducibility of aortic root measurements is not ideal and needs to be considered in patient follow-up and2 (2) pathological aortic dilation most often occurs in older individuals raising the concern that athletic activity as a teenager or young adult might affect aortic size decades later. They conclude that: ’While a …