Association of aortic root diameter and vascular function with an exaggerated blood pressure response to exercise among elite athletes

The systolic blood pressure/workload (SBP/MET) slope was recently reported to reliably identify an exaggerated blood pressure response (eBPR) in the normal population and in athletes. We investigated whether the aortic root diameter (AoD) also correlates with an eBPR and vascular function in elite athletes.

We examined 652 healthy male elite athletes (age 25.8 ± 5 years) of mixed sports with a standardized maximum exercise test. Central blood pressure and vascular function were measured non-invasively with a validated oscillometric device. The SBP/MET slope was calculated and the threshold for an eBPR was set at > 6.2 mmHg/MET. Two groups were defined (≤ 6.2 and > 6.2 mmHg/MET), and an association between AoD and vascular function with the SBP/MET slope was evaluated for each group.

Athletes with an eBPR (n = 191, 29%) displayed a higher systolic central BP (103 ± 7.7 vs. 101 ± 9.2 mmHg, p = 0.004), larger AoD (32.8 ± 3.3 vs. 31.9. ± 3.2 mm, p < 0.001), a higher AoD/left ventricular end-diastolic diameter (LVEDD) ratio (0.62 ± 0.061 vs. 0.59. ± 0.056, p < 0.001), a lower LVEDD/AoD ratio (1.64 ± 0.16 vs. 1.69. ± 0.16, p < 0.001), and a lower absolute (299 ± 59 vs. 379 ± 65 W, p < 0.001) and relative workload (3.17 ± 0.55 vs. 4.05 ± 1.2 W/kg, p < 0.001) vs. athletes with a normal SBP/MET slope (n = 461, 71%). No differences between the two groups were found after indexing AoD to body surface area (BSA) (14.76 ± 1.36 vs. 14.73 ± 1.41, p = 0.772).

Athletes with eBPR displayed altered AoD/LVEDD and LVEDD/AoD ratios, whereas AoD/BSA indexing was not different. Further longitudinal studies are encouraged to explore these metrics and their role in aortic remodeling of athletes.