Chatrath, N; O'Driscoll, J; Sharma, S; Papadakis, M
(2023)
Aortic regurgitation in athletes: the challenges of echocardiographic interpretation.
Echo Res Pract, 10 (1).
p. 20.
ISSN 2055-0464
https://doi.org/10.1186/s44156-023-00033-w
SGUL Authors: Chatrath, Nikhil
Abstract
BACKGROUND: Bicuspid aortic valve (BAV) is the most common congenital cardiac defect and prone to premature degeneration causing aortic regurgitation (AR). The assessment of AR in athletic individuals poses several challenges as the pathological left ventricle (LV) remodelling caused by AR may overlap with the physiological remodelling of intense exercise. The purpose of this study is to highlight these challenges, review the existing literature and discuss how to tackle these conundrums. As a real-world example, we compare the resting transthoracic echocardiographic (TTE) findings in a cohort of individuals with BAV and AR, sub-grouped into "highly active" or "lightly active". METHODS: Adult male subjects with an index TTE performed at a tertiary referral centre between 2019 and 2022 were included if the TTE confirmed a BAV and at least moderate AR. Further strict inclusion criteria were applied and parameters of valve disease severity was made in accordance with existing guidelines. Subjects completed a physical activity questionnaire over the telephone, and were classified into either group 1: "highly active" or group 2: "lightly active" based on their answers. Demographics and TTE parameters were compared between the two groups. RESULTS: 30 male subjects (mean age 44 ± 13 years) with BAV-AR were included - 17 were highly active, and 13 lightly active. There was no significant difference in age (group 1, 45 ± 12.7 years vs. group 2, 42 ± 17 years; p = 0.49), height (p = 0.45), weight (p = 0.268) or severity of AR, when quantitative assessment was possible. Group 1 had a significantly higher stroke volume (131 ± 17mls vs. 102 ± 13 mls; p = 0.027), larger LV volumes, diastolic dimensions and significantly larger bi-atrial and right ventricular size. This LV dilatation in the context of AR and athleticism poses a diagnostic and management conundrum. Despite this, none of these 17 highly active individuals demonstrated any of the traditional criteria used to consider surgery. CONCLUSION: There is significant overlap between the physiological adaptations to exercise and those caused by AR. Multi-modality imaging and stress testing can aid clinicians in diagnostic and management decisions in exercising individuals when there is discordance between AR severity and symptoms.
Item Type: |
Article
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Additional Information: |
© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
Keywords: |
Aortic regurgitation, Athlete, Bicuspid aortic valve, Exercise |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Echo Res Pract |
ISSN: |
2055-0464 |
Language: |
eng |
Dates: |
Date | Event |
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13 December 2023 | Published | 11 October 2023 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
Project ID | Funder | Funder ID |
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UNSPECIFIED | Cardiac Risk in the Young | UNSPECIFIED |
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PubMed ID: |
38087295 |
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Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/115936 |
Publisher's version: |
https://doi.org/10.1186/s44156-023-00033-w |
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