Aortic Valve Annular Geometry in Athletes Practicing Sports with High Dynamics-A Detailed Three-Dimensional...

Background. Physiological remodeling resulting from chronic exercise-induced volume and pressure overload is a well-recognized characteristic of the athlete's heart. This study aimed to explore potential changes in three-dimensional speckle-tracking echocardiography-derived aortic valve annular (AVA) dimensions and dynamics in elite athletes engaged in high-dynamic sports with varying degrees of static components. Furthermore, we sought to determine whether these parameters differ depending on the magnitude of the sport's dynamic component. Methods. The athlete cohort included 56 individuals and was divided into three groups based on the static component of their sport: C. I. (high dynamic/low static) consisted of 13 elite athletes (mean age: 22.7 ± 3.8 years, 5 males), C. II. (high dynamic/moderate static) consisted of 18 elite athletes (mean age: 23.0 ± 4.6 years, 6 males) and C. III. (high dynamic/high static) consisted of 25 elite athletes (mean age: 21.7 ± 4.5 years, 9 males). Data of athletes were compared with those of 38 age- and sex-matched healthy non-athletic individuals (mean age: 23.8 ± 2.5 years, 14 males). Results. AVA dimensions did not differ significantly between athletes and controls nor among the athlete subgroups. AVA plane systolic excursion (AAPSE) was increased in all athletes compared with controls (1.31 ± 0.30 cm vs. 1.18 ± 0.36 cm, p < 0.05). All athletes showed a significantly larger proportion of individuals showing larger end-diastolic AVA than end-systolic AVA (55% vs. 24%, p < 0.05). All athletes demonstrated reduced basal LV-RS (26.5 ± 13.9% vs. 31.5 ± 13.2%, p < 0.05) and increased basal LV-LS (-21.4 ± 4.4 vs. 19.9 ± 4.2%, p < 0.05) compared with controls. This pattern of findings was consistent across all athlete subgroups. Conclusions. Although AVA is not dilated in elite athletes practicing dynamic sports, its spatial displacement, as represented by AAPSE, together with increased basal LV-LS and a higher proportion of larger end-diastolic AVA, is augmented, while basal LV-RS is reduced. These findings suggest a functional shift from radial contraction toward enhanced longitudinal dynamics. All these findings appear to be independent of the static component of dynamic sports.