Aortic elastic properties in athletes with Marfanoid habitus: the need for early and accurate diagnostic methods

Erdem Kasikcioglu

Consultant Cardiologist in Sports Medicine
Istanbul University
Istanbul Faculty of Medicine
Sports Medicine Department
Istanbul, Turkey
Tel: +90 216 3405316
Fax: +90 216 3405316
E-mail address: ekasikcioglu{at}yahoo.com

It was with great interest that I read the paper by Nollen et al.1 on the predictive value of aortic stiffness on the occurrence of progressive aortic dilatation in patients with Marfan syndrome. Their major finding was that aortic distensibility is an independent predictor of progressive aortic dilatation.

The early diagnosis of Marfan syndrome and the identification of patients at high risk of aortic complication are still important.13 Although quantification of individual aortic root growth using a newly developed formula may serve to establish the diagnosis, the discrimination formula may still need to be tested in a different Marfan population to find true sensitivity and specificity values.2

Moreover, blood pressure increases during physical effort, which causes stress to aortic walls, with a possible more rapid progression of the disease. Identification of Marfan syndrome is therefore of the greatest importance in sports cardiology.3 Furthermore, the prevalence of aortic dilatation may be unexpectedly high among athletes, but no such data concerning the prevalence of Marfan syndrome are currently available. The prevalence of aortic dilatation among basketball and volleyball players was more than 10 times greater than among other athletes.3 Intensive physical activity is largely restricted for persons with Marfan syndrome because of the increases in volume and pressure load, which can be acutely deleterious to the weakened aorta.3

Aortic mechanical functions in athletes show excellent adaptation (like a secondary pump) and this depends on exercise type, duration, and capacity.4,5 These changes positively affect left ventricular performance, especially diastolic functions.4,5 Increased stiffness with decreased left ventricular function in athletes may be a signal for cardiovascular risk.

Although the diagnosis of Marfan syndrome without gradual aortic dilatation remains a difficult entity using the standard diagnostic criteria, it strikes me that periodic measurements of aortic stiffness in athletes may provide a useful tool for diagnosis at an earlier stage. Also, the importance of diagnosis in athletes before major complications might justify such an additional effort.

References

  1. Nollen GJ, Groenink M, Tijssen JGP et al. Aortic stiffness and diameter predict progressive aortic dilatation in patients with Marfan syndrome. Eur Heart J 2004;25:1146–1152.[Abstract/Free Full Text]
  2. Groenink M, Rozendaal L, Naeff MSJ et al. Marfan syndrome in children and adolescents: predictive and prognostic value of aortic root growth for screening for aortic complications. Heart 1998;80:163–169.[Abstract/Free Full Text]
  3. Kinoshita N, Mimura J, Obayashi C et al. Aortic root dilatation among young competitive athletes: echocardiographic screening of 1929 athletes between 15 and 34 years of age. Am Heart J 2000;139:723–728.[ISI][Medline]
  4. Kasikcioglu E, Oflaz H, Akhan H et al. Aortic distensibility in endurance athletes. Acta Cardiol 2003;58:243–244.
  5. Kasikcioglu E, Oflaz H, Akhan H et al. Left ventricular remodeling and aortic distensibility in elite power athletes. Heart Vessels 2004;19:183–188.[ISI][Medline]




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