Aortic Dimension in Elite Athletes: Updated Systematic Review and Meta-Analysis.

Aims: To assess the presence and the extent of an "aortic remodeling" in elite athletes.

Methods: A systematic review and meta-analysis of literature were conducted for studies (1981-2024) reporting echocardiographic aortic diameters of elite athletes compared to non-athlete healthy controls. Among the 5,494 studies retrieved, 21 (9,464 elite athletes vs. 2,637 non-athlete controls) fulfilled all eligibility criteria. Data were aggregated using a random effects model for estimating the pooled risk ratio and mean difference.

Results: Absolute aortic diameters at the sinus of Valsalva (AoSV) were higher in overall elite athletes compared to non-athlete healthy controls (mean difference [MD] 1.69 [95% CI 1.01-2.37] mm; p <0.001) and if stratified to sex. This difference was maintained if AoSV was indexed to height (AoSV/h) (MD 0.04 [95% CI -0.00-0.08] mm/m; ES 2.18 [95% CI 1.10-3.26]; p<0.001). The analysis of AoSV/h according to sex was not performed for the paucity of studies. However, when indexed to body surface area (AoSV/BSA), no differences were found between the two groups (MD 0.04 [95% CI -0.25-0.34] mm/m2; p = 0.880), also according to sex. Above findings were not influenced by age.

Conclusions: Absolute AoSV was mildly larger in athletes compared to non-athlete healthy controls, even when indexed to height. However, no differences were evident when indexed by BSA, irrespective of sex, type of sport and age. Therefore, assessment of the aortic size in elite athletes should consider the proper normalization in order to avoid misdiagnosis of aortopathies.

Prospero Registry Id: CRD42024561255.