Key words: Bicuspid aortic valve; athletes; valvulo-aortopathy
Why is this study important?
Bicuspid aortic valve (BAV) is the most common congenital heart valve disease in the general population, including young athletes. BAV is considered a significant valvulo-aortopathy because BAV patients may experience worsening valve function as well as aortic dilatation and decreased aortic elasticity, which can increase the risk of aortic dissection. Multiple factors influence the progression of these complications in BAV patients, and the role of sports activity in this progression remains unclear. Intense physical activity might exacerbate the condition, leading to a higher risk of worsening valve function and aortic dissection or rupture. However, the existing studies are few and have small sample sizes. To address this gap, we conducted an international multi-center study comparing competitive athletes with BAV to non-athletes with BAV and competitive athletes with normal valve (TAV) to determine whether these populations differ regarding aortic size and valve function (1).
How did the study go about this?
The first phase of the project involved a cross-sectional study designed to assess valve function and ascending aortic dimensions and establish the prevalence of aortic dilatation and aortic regurgitation or stenosis in athletes with BAV, compared to athletes with TAV and non-athletes with BAV. Echocardiography was used to evaluate valve function, aortic size, and bi-ventricular measurements.
What did the study find?
Competitive athletes with BAV had similar aortic dimensions to non-athletes with BAV but larger than athletes with TAV, demonstrating no differences in aortic dimensions between athletes and non-athletes with BAV. Additionally, both athletes and non-athletes with BAV showed a higher mean gradient and a greater occurrence of mild stenosis or regurgitation compared to TAV athletes. However, there were no significant differences within the BAV groups. Notably, athletes with BAV had larger left ventricular volumes and mass compared to both TAV athletes and non-athletes with BAV, suggesting a distinct pattern of left ventricular re-modelling in BAV athletes.
What are the key take-home points?
These results suggest that competitive athletes with BAV are not significantly different from non-athletes with BAV. However, given the greater left ventricular remodelling, larger aortic diameters, and worse aortic valve function observed in BAV individuals compared to athletes with TAV, close, longitudinal follow-up is necessary.
Authors: Flavio D’Ascenzi, MD, PhD; Luna Cavigli, MD, PhD. Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Siena, Italy
References:
- D’Ascenzi F, Cavigli L, Cameli M, et alSport PRactice and its Effects on aortic size and valve function in bicuspid Aortic valve Disease: a cross-sectional report from the SPREAD study British Journal of Sports Medicine Published Online First: 16 August 2024. doi:10.1136/bjsports-2023-107772