Cardiovascular Performance Program, Massachusetts General Hospital, Boston.
Echocardiography Laboratory, Massachusetts General Hospital, Boston.
JAMA Cardiol. 2020 May 1;5(5):522-531. doi: 10.1001/jamacardio.2020.0054.
Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling.
To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019.
Long-term endurance exercise.
The primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable.
Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size.
Clinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.
在临床实践中，衰老的耐力运动员中经常会出现主动脉扩张，但该人群的主动脉大小分布情况尚不清楚。此外，这是否可能代表主动脉对长期运动的适应，类似于已经确立的心室重构过程，也不确定。
评估具有约 20 年运动史的长期大师级男性和女性运动员中主动脉扩张的患病率。
设计、环境和参与者：这项横断面研究评估了资深耐力运动员的主动脉大小。2018 年 2 月至 10 月，从美国各地的竞技体育赛事中招募了年龄在 50 至 75 岁的大师级赛艇运动员和跑步运动员。分析于 2019 年 1 月开始。
长期耐力运动。
主要结果是使用经胸超声心动图根据当代指南测量的窦房结和升主动脉的主动脉大小。将主动脉尺寸与年龄、性别和体表面积校正的预测值进行比较，并在适用的情况下计算 z 分数。
在 442 名运动员（平均[标准差]年龄 61[6]岁；267 名男性[60%]；228 名赛艇运动员[52%]；214 名跑步运动员[48%]）中，经临床确定的主动脉扩张，定义为窦房结或升主动脉直径为 40 毫米或更大，21%（n=94）的所有参与者均存在（83 名男性[31%]和 11 名女性[6%]）。与公布的列线图相比，测量的主动脉大小分布显示出右移和右尾（均 P<0.001）。总体而言，105 人（24%）至少有 1 个 z 分数为 2 或更高，表明主动脉测量值高于人群平均值 2 个标准差以上。在调整年龄、性别、体型、高血压和他汀类药物使用的多变量模型中，精英运动员身份（参加世界锦标赛或奥运会的赛艇比赛或马拉松时间在 2 小时 45 分钟以内）和运动类型（赛艇）与主动脉大小独立相关。
在衰老的耐力运动员中，临床相关的主动脉扩张很常见，这可能提示长期运动后的血管重塑。需要进行纵向随访，以确定该人群的相关临床结局。
