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Original article
Echocardiographic measurements of aortic root diameter (ARD) in collegiate football Athletes at pre-participation evaluation
  1. Fred Reifsteck1,
  2. James R Clugston2,
  3. Stephen Carek2,
  4. Kimberly G Harmon3,
  5. Breton Michael Asken4,
  6. Michael C Dillon5,
  7. Joan Street6,
  8. Katherine M Edenfield2
  1. 1University Health Center, University of Georgia Athletic Association, University of Georgia, Athens, Georgia, USA
  2. 2Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
  3. 3Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
  4. 4Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
  5. 5The Cardiac and Vascular Institute, Gainesville, Florida, USA
  6. 6Student Health Care Center, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Fred Reifsteck; freifsteck{at}uhs.uga.edu

Abstract

Background Some remodelling of the aortic root may be expected to occur with exercise but can already vary due to different body sizes, compositions and genetic predispositions. Attributing the cause of borderline aortic root diameter (ARD) values to either physiological or pathological conditions in American college football athletes is difficult as there is very limited normal reference values in this population. Body surface area (BSA) specific norms are thought to be useful in other cardiac measurements of football athletes.

Methods A retrospective cohort review of pre-participation examination (PPE) transthoracic echocardiogram data from collegiate football athletes was performed. ARD was analysed by field position (linemen, n=137; non-linemen, n=238), race (black, n=216; white, n=158) and BSA for predictive value and associations. Values were compared with non-athlete norms, and collegiate football athlete-specific normal tables were created.

Results Only 2.7% of football athletes had ARD measurements above normal non-athlete reference values and the mean athlete ARD values were lower than non-athlete values. No athletes had an aortic root >40 mm or were disqualified due to underlying cardiac pathology. Univariate analyses indicated linemen position and increasing BSA was associated with larger values for ARD. BSA outperformed race in predicting ARD. Normal tables were created for ARD stratified by BSA group classification (low, average and high BSA). Proposed clinical cut-offs for normal and abnormal values are reported for raw echocardiograph metrics and their BSA indexed scores.

Conclusions Non-athlete reference values for ARD appear applicable for defining upper limits of normal for most collegiate football athletes. BSA-specific normal values may be helpful in interpreting results for athletes that exceed non-athlete norms.

  • college football
  • echocardiogram
  • aortic root diameter

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsem-2019-000546

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    Footnotes

    • Contributors FR, JC and KME contributed to planning, conduct and reporting. SC, KH, BMA, MD and JS contributed to review of the manuscript.

    • Funding This work was supported in part by The American Medical Society for Sports Medicine (AMSSM) Foundation Research Grant 2016 awarded to KME, and the University of Florida REDCap utilizes the NIH National Center for Advancing Translational Sciences (NCATS) grant UL1 TR000064. Publication of this article was funded by the University of Georgia Health Center.

    • Competing interests JS is a part time consultant in the capacity of quality assurance technologist for Athletic Heart, LLC.

    • Patient consent for publication Not required.

    • Ethics approval The University of Florida Institutional Review Board and the University of Georgia Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.