Scaling to produce size-independent indices of echocardiographic derived aortic root dimensions in elite Rugby Football League players

The assessment of aortic root dimensions is important in cardiac pre-participation screening. Scaling of cardiac dimensions removes the impact of body size allowing meaningful inter/intra group comparisons. Developing appropriate scaling approaches, scaling variables and extending the application to major vessels is warranted so underlying pathology can be detected and managed appropriately. The study aims to define relationships between aortic root dimensions and body surface area/height. Two hundred and twenty elite Rugby Football League athletes were recruited. All participants completed anthropometric assessments, a 12-lead ECG and echocardiogram. Aortic root was measured at the aortic annulus, sinus of valsalva, sinotubular junction and the proximal ascending aorta. Linear and allometric scaling were performed on the relationship between aortic measurements and body surface area/height. Absolute aortic root measurements fell within normal population data (mean ± standard deviation (range): aortic annulus: 22 ± 2 (17–28) mm, sinus of valsalva: 28 ± 3 (20–38) mm, sinotubular junction: 22 ± 3 (14–33) mm, proximal ascending aorta: 22 ± 3 (15–31) mm). Linear scaling to height produced size-independent indices at all aortic measurement sites (P < 0.05). Conversely, linear scaling using body surface area did not produce size-independent indices at any site (P > 0.05). Allometric scaling, using both body surface area and height, produced size-independent indices at all sites (P < 0.05). We recommend linearly scaling aortic root dimensions to height in elite Rugby Football League athletes and discourage the use of body surface area as a linear scaling quantity. Allometric scaling is also effective when using both body surface area and height.

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Aortic root remodelling in competitive athletes

European Journal of Preventive Cardiology ◽

10.1177/2047487319894882 ◽

2019 ◽

Vol 27 (14) ◽

pp. 1518-1526 ◽

Cited By ~ 3

Author(s):

Marc Abulí ◽

Gonzalo Grazioli ◽

Maria Sanz de la Garza ◽

Silvia Montserrat ◽

Bàrbara Vidal ◽

...

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Aortic Root ◽

Allometric Scaling ◽

Cross Sectional Study ◽

Aortic Dilatation ◽

Reference Ranges ◽

Cross Sectional ◽

Competitive Athletes

Background Controversy remains about the cut-off limits for detecting aortic dilatation in athletes, particularly in large-sized individuals. The allometric scaling model has been used to obtain size-independent measurements in cardiovascular structures in the general population. Aim The purpose of this study was to validate the use of allometric scaling in the measurement of the aortic root for competitive athletes and to offer reference values. Methods This was a cross-sectional study that analyses the dimensions of aortic root found in the echocardiogram performed as part of pre-participation sports screening in competitive athletes between 2012–2015. Beta exponents were calculated for height and body surface area in the whole cohort. In order to establish whether a common exponent could be used in both genders the following model was assessed y = a xb*exp(c*sex). If a common exponent could not be applied then sex-specific beta exponents were calculated. Results Two thousand and eighty-three athletes (64% men) were included, from a broad spectrum of 44 different sports disciplines, including basketball, volleyball and handball. The mean age was 18.2 ± 5.1 years (range 12–35 years) and all athletes were Caucasian, with a training load of 12.5 ± 5.4 h per week. Indexed aortic root dimension showed a correlation with ratiometric scaling by body surface area (r: −0.419) and generated size independence values with a very light correlation with height (r: −0.084); and with the allometric scaling by body surface area (r: −0.063) and height (r: −0.070). The absolute value of aortic root was higher in men than in women ( p < 0.001). These differences were maintained with allometric scaling. Conclusion Size-independent aortic root dimension values are provided using allometric scaling by body surface area and height in a large cohort of competitive athletes. Aortic root values were larger in men than in women, both in absolute values and after allometric scaling. The use of these indexed aortic reference ranges can be useful for the early detection of aortic pathologies.

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Aortic valve replacement in elderly with small aortic root and low body surface area; the Perceval S valve and its impact in effective orifice area

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-016-0438-7 ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 18

Author(s):

Panagiotis Dedeilias ◽

Nikolaos G. Baikoussis ◽

Efstathia Prappa ◽

Dimitrios Asvestas ◽

Michalis Argiriou ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Surface Area ◽

Body Surface Area ◽

Valve Replacement ◽

Body Surface ◽

Aortic Root ◽

Effective Orifice Area ◽

Orifice Area ◽

Small Aortic Root

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Exploring the Aortic Root Diameter and left Ventricle Size Among Lithuanian Athletes

10.20944/preprints201809.0357.v1 ◽

2018 ◽

Author(s):

Renata Žumbakytė-Šermukšnienė ◽

Agnė Slapšinskaitė ◽

Miglė Baranauskaitė ◽

Julija Borkytė ◽

Rasa Sederevičiūtė ◽

...

Keyword(s):

Left Ventricle ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Aortic Root ◽

Female Athletes ◽

The Body ◽

Endurance Athletes ◽

Physical Workload ◽

Lv Mass

Aortic rupture is known as one of the potential causes of sudden cardiac death in athletes. Nevertheless, adaptation strategies for aortic root dilation in athletes vary. The purpose of this study was to investigate aortic root adaptation to physical workload and to determine if aortic root’s and left ventricle sizes are contingent upon the physical workload. Echocardiography was applied to 151 subjects to measure the aortic root at aortic valve annulus (AA) and at sinus of Valsalva (VS). 122 were athletes (41 females and 81 males) and 29 were non-athletes (14 females and 15 males). Of the 41 female athletes, 32 were endurance athletes, and 9 strength athletes. From 81 male athletes, 56 were endurance athletes, and 25 were strength athletes. AA and VS mean values for the body surface area were presented as rAA and rVS. Left ventricle (LV) meaures incuded LV end-diastolic diameter (LVEDD), interventricular septum thickness in diastole (IVSTd), LV posterior wall thickness in diastole (LVPWTd), LV mass (LVM), LV mass index, LV end-diastolic diameter index (LVEDDI). Results indicated that VS was higher in female athletes (28.9±2.36mm) than in non-athletes (27.19±2.87mm, p=0.03). On the other hand, rAA was higher in strength athletes (12.19±1.48mm/m2) than in endurance athletes (11.12±0.99mm/m2, p=0.04). Additionally, rVS and rAA were higher in female strength athletes (17.19±1.78mm/m2, 12.19±1.48mm/m2) than female basketball players (15.49±1.08mm/m2, p=0.03, 10.75±1.06 mm/m2, p=0.02). Statistically significant positive moderate correlations were found between VS and LVEDD, LVM, IVSTd, LVPWTd, rVS and LVEDDI parameters in all athletes. The diameter of Valsalva sinus was greater in female athletes compared to non-athletes. The rAA mean value for body surface area was greater in female athletes practising strength sports as compared to their counterparts who were practising endurance sports. The diameter of the aortic root at sinuses positively correlated with the LV size in all athletes. Trial was registered at ClinicalTrials.gov Identifier: NCT03656861, September 3, 2018 (retrospectively registered).

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Exploring the Aortic Root Diameter and Left Ventricle Size among Lithuanian Athletes

Medicina ◽

10.3390/medicina55060271 ◽

2019 ◽

Vol 55 (6) ◽

pp. 271 ◽

Cited By ~ 1

Author(s):

Renata Žumbakytė-Šermukšnienė ◽

Agnė Slapšinskaitė ◽

Miglė Baranauskaitė ◽

Julija Borkytė ◽

Rasa Sederevičiūtė ◽

...

Keyword(s):

Left Ventricle ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Aortic Root ◽

Female Athletes ◽

Endurance Athletes ◽

Physical Workload ◽

Relative Index ◽

Lv Mass

Background and objectives: Aortic rupture is known as one of the potential causes of sudden cardiac death in athletes. Nevertheless, adaptation strategies for aortic root dilation in athletes vary. The purpose of this study was to investigate aortic root adaptation to physical workload and to determine if aortic roots and left ventricle sizes are contingent upon the physical workload. Materials and Methods: Echocardiography was applied to 151 subjects to measure the aortic root at aortic valve annulus (AA) and at sinus of Valsalva (VS). 122 were athletes (41 females and 81 males) and 29 were non-athletes (14 females and 15 males). Of the 41 female athletes, 32 were endurance athletes, and 9 were strength athletes. From 81 male athletes, 56 were endurance athletes, and 25 were strength athletes. AA and VS mean values for the body surface area were presented as AA relative index with body surface area (rAA) and VS relative index with body surface area (rVS). Left ventricle (LV) measures included LV end-diastolic diameter (LVEDD), interventricular septum thickness in diastole (IVSTd), LV posterior wall thickness in diastole (LVPWTd), LV mass (LVM), LV mass index, and LV end-diastolic diameter index (LVEDDI). Results: Results indicated that VS was higher in female athletes (28.9 ± 2.36 mm) than in non-athletes (27.19 ± 2.87 mm, p = 0.03). On the other hand, rAA was higher in strength athletes (12.19 ± 1.48 mm/m2) than in endurance athletes (11.12 ± 0.99 mm/m2, p = 0.04). Additionally, rVS and rAA were higher in female strength athletes (17.19 ± 1.78 mm/m2, 12.19 ± 1.48 mm/m2) than female basketball players (15.49 ± 1.08 mm/m2, p = 0.03, 10.75 ± 1.06 mm/m2, p = 0.02). No significant differences regarding aortic root were found between male athletes and non-athletes. Statistically significant positive moderate correlations were found between VS and LVEDD, LVM, IVSTd, LVPWTd, rVS, and LVEDDI parameters in all athletes. Conclusion: The diameter of Valsalva sinus was greater in female athletes compared to non-athletes. The rAA mean value for body surface area was greater in female athletes practising strength sports as compared to their counterparts who were practising endurance sports. The diameter of the aortic root at sinuses positively correlated with the LV size in all athletes.

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Comparison of Aortic Root Diameter to Left Ventricular Outflow Diameter Versus Body Surface Area in Patients With Marfan Syndrome

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.06.062 ◽

2012 ◽

Vol 110 (10) ◽

pp. 1518-1522 ◽

Cited By ~ 6

Author(s):

Hadas Shiran ◽

Francois Haddad ◽

David Craig Miller ◽

David Liang

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Marfan Syndrome ◽

Body Surface ◽

Aortic Root ◽

Root Diameter ◽

Left Ventricular ◽

Left Ventricular Outflow

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Prophylactic aortic root surgery in patients with Marfan syndrome: 10 years’ experience with a protocol based on body surface area

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.04.035 ◽

2008 ◽

Vol 34 (3) ◽

pp. 589-594 ◽

Cited By ~ 8

Author(s):

Jan J.J. Aalberts ◽

Tjalling W. Waterbolk ◽

J. Peter van Tintelen ◽

Hans L. Hillege ◽

Piet W. Boonstra ◽

...

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Marfan Syndrome ◽

Body Surface ◽

Aortic Root ◽

Aortic Root Surgery

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Body surface area as a key determinant of aortic root and arch dimensions in a population-based study

Experimental and Therapeutic Medicine ◽

10.3892/etm.2012.839 ◽

2012 ◽

Vol 5 (2) ◽

pp. 406-410 ◽

Cited By ~ 1

Author(s):

YAN-LI WANG ◽

QING-LING WANG ◽

LIANG WANG ◽

YING-BIAO WU ◽

ZHI-BIN WANG ◽

...

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Aortic Root ◽

Population Based ◽

Population Based Study

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Reference values of left heart echocardiographic dimensions and mass in male peri-pubertal athletes

European Journal of Preventive Cardiology ◽

10.1177/2047487318776084 ◽

2018 ◽

Vol 25 (11) ◽

pp. 1204-1215 ◽

Cited By ~ 22

Author(s):

Elena Cavarretta ◽

Francesco Maffessanti ◽

Fabio Sperandii ◽

Emanuele Guerra ◽

Federico Quaranta ◽

...

Keyword(s):

Body Mass Index ◽

Left Atrium ◽

Surface Area ◽

Left Ventricular Mass ◽

Body Surface Area ◽

Body Surface ◽

Aortic Root ◽

Left Ventricular ◽

Left Heart ◽

And Training

Background Several articles have proposed reference values in healthy paediatric subjects, but none of them has evaluated a large population of healthy trained adolescents. Design The study purpose was to establish normal echocardiographic measurements of left heart (aortic root, left atrium and left ventricular dimensions and mass) in relation to age, weight, height, body mass index, body surface area and training hours in this specific population. Methods We retrospectively evaluated 2151 consecutive, healthy, peri-pubertal athletes (100% male, mean age 12.4 ± 1.4 years, range 8–18) referred to a single centre for pre-participation screening. All participants were young soccer athletes who trained for a mean of 7.2 ± 1.1 h per week. Results Left ventricular internal diameters, wall thickness, left ventricular mass, aortic root and left atrium diameters were significantly correlated to age, body surface area, height and weight ( p < 0.01). Age, height, weight and body surface area were found associated with chamber size, while body mass index and training hours were not. Inclusion of both age and body size parameters in the statistical models resulted in improved overall explained variance for diameters and left ventricular mass. Conclusion Equations, mean values and percentile charts for the different age groups may be useful as reference data in efficiently assessing left ventricular parameters in young athletes.

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Allometric Scaling Factors for Oxygen Uptake during Exercise in Children

Pediatric Exercise Science ◽

10.1123/pes.7.1.12 ◽

1995 ◽

Vol 7 (1) ◽

pp. 12-25 ◽

Cited By ~ 16

Author(s):

Danette M. Rogers ◽

Kenneth R. Turley ◽

Kathleen I. Kujawa ◽

Kevin M. Harper ◽

Jack H. Wilmore

Keyword(s):

Oxygen Consumption ◽

Body Size ◽

Surface Area ◽

Body Surface Area ◽

Body Mass ◽

Body Surface ◽

Allometric Scaling ◽

Scaling Factors ◽

Treadmill Testing ◽

The Relationship

This study was designed to examine the relationship between oxygen consumption and both body surface area and body mass in children to determine what allometric scaling factors from these variables provide appropriate means of expressing data for this population. These scaling factors were then compared to exponents based on theoretical and animal models to determine if the same relationships were present. Forty-two children (21 boys and 21 girls) 7 to 9 years of age participated in maximal and submaximal treadmill testing. The submaximal V̇O2 to body size relationship proved to be a more appropriate factor to use when scaling V̇O2 than the relationship seen between body size and V̇O2max. Therefore, in this population of children, V̇O2 relative to body surface area or body mass to the power 0.67, demonstrated submaximally, provided a more appropriate means of data expression both statistically and physiologically than the traditional expression of V̇O2 relative to body mass (ml·kg−1·min−1).

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