Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport

There is limited information regarding the aortic root upper physiological limits in all planes in elite athletes according to static and dynamic cardiovascular demands and sex.

A cross-sectional study was performed in 3281 healthy elite athletes (2039 men and 1242 women) aged 23.1±5.7 years, with body surface area of 1.9±0.2 m² and 8.9±4.9 years and 19.2±9.6 hours/week of training. Maximum end-diastolic aortic root diameters were measured in the parasternal long axis by 2-dimensional echocardiography. Age, left ventricular mass, and body surface area were the main predictors of aortic dimensions. Raw values were greater in males than in females (P<0.0001) at all aortic root levels. Dimensions corrected by body surface area were higher in men than in women at the aortic annulus (13.1±1.7 versus 12.9±1.7 mm/m²; P=0.007), without significant differences at the sinus of Valsalva (16.3±1.9 versus 16.3±1.9 mm/m²; P=0.797), and were smaller in men at the sinotubular junction (13.6±1.8 versus 13.8±1.8 mm/m²; P=0.008) and the proximal ascending aorta (13.8±1.9 versus 14.1±1.9 mm/m²; P=0.001). Only 1.8% of men and 1.5% of women had values >40 mm and 34 mm, respectively. Raw and corrected aortic measures at all levels were significantly greater in sports, with a high dynamic component in both sexes, except for corrected values of the sinotubular junction in women.

Aortic root dimensions in healthy elite athletes are within the established limits for the general population. This study describes the normal dimensions for healthy elite athletes classified according to sex and dynamic and static components of their sports.