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ASCENDING AORTIC DIMENSIONS IN FORMER NATIONAL FOOTBALL LEAGUE ATHLETES
1413 JACC March 21, 2017 Volume 69, Issue 11
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) ASCENDING AORTIC DIMENSIONS IN FORMER NATIONAL FOOTBALL LEAGUE ATHLETES Moderated Poster Contributions Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C Saturday, March 18, 2017, 12:30 p.m.-12:40 p.m. Session Title: Hearts and Soles: Multimodality Imaging in Athletes Abstract Category: 31. Non Invasive Imaging: Sports and Exercise Presentation Number: 1225M-03 Authors: James L. Gentry, David Carruthers, Christopher Maroules, Parag Joshi, Colby Ayers, Philip Aagaard, Rory Hachamovitch, Reginald Dunn, Andrew Lincoln, Andrew Tucker, Kezia Alexander, Dermot Phelan, Heart and Vascular Institute at the Cleveland Clinic, Cleveland, OH, USA, University of Texas Southwestern Medical Center, Dallas, TX, USA
Background: Ascending aortic dimensions are slightly larger in athletes compared to sedentary controls and almost rarely > 4 cm. It is unknown whether past exposure to the hemodynamic stress of repetitive strenuous exercise translates into differences in aortic dimensions in former elite athletes. Methods: This is a retrospective, cross-sectional study of 206 former National Football League (NFL) athletes compared with 759 male subjects from the Dallas Heart Study (DHS). Mid-ascending aortic dimensions were obtained from computed tomographic scans performed as part of a screening protocol (NFL) or as part of the DHS protocol. Results: Baseline characteristics are shown in the Table. Compared to a population based control, former NFL athletes had significantly larger ascending aortic diameters (3.8 ± 0.5 cm vs. 3.4 ± 0.4 cm; p< 0.0001). A significantly higher proportion of retired NFL players had an aorta of > 4 cm (29.6% versus 8.6%, p=<0.0001). After adjusting for age, race, body surface area, systolic blood pressure, history of hypertension, current smoking, and diabetes the former NFL players still had significantly larger aortas (Table). Former NFL players were twice as likely to have an aorta > 4 cm after adjusting for the same parameters (Table). Conclusions: Ascending aortic dimensions are significantly larger in former NFL athletes even accounting for their size, age, and risk factors. Whether this translates to an increased risk is unknown and requires further evaluation. Baseline Characteristics Age, years BSA, m2 SBP, mmHg Non-HDL-C, mg/dl HDL-C, mg/dl Aorta, cm African American Hypertension Diabetes Current Smoking Potentially Important Predictors of Aortic Size Unadjusted (n = 965) NFL vs. DHS Constant Adjusted (n = 932) NFL vs. DHS Age, years African American SBP, mmHg Hypertension Diabetes Current smoking BSA, m2 Constant Odds Ratio for having an Aortic Size > 4 cm
Table. Baseline characteristics of the study population and predictors of aortic size. DHS (n =759) 53.6 (8.3) 2.1 (0.2) 134.9 (18) 143.9 (41.4) 48.3 (13.4) 3.4 (0.4) 400 (52.7%) 416 (54.8%) 128 (16.9%) 196 (26.5%)
NFL (n = 206) 57.1 (10.3) 2.4 (0.2) 132 (15.6) 127.5 (37.9) 53.9 (14.9) 3.8 (0.5) 97 (47.1%) 76 (36.9%) 31 (15.1%) 18 (8.7%)
p-value < 0.0001 < 0.0001 0.163 < 0.0001 < 0.0001 < 0.0001 0.158 < 0.0001 0.597 < 0.0001
Unstandardized Coefficient
Standard Error
p-value
0.37 3.44
0.03 0.02
< 0.0001 < 0.0001
0.22 0.02 -0.05 0.002 0.07 -0.05 0.003 0.38 1.19
0.04 0.0002 0.03 0.001 0.03 0.04 0.03 0.06 0.20
< 0.0001 < 0.0001 0.053 0.030 0.022 0.183 0.918 < 0.0001 < 0.0001
Odds ratio p-value Unadjusted (n =126, aorta > 4 cm) NFL vs. DHS 4.49 (95% CI: 3.03 - 6.65) <0.0001 Adjusted (n=124, aorta > 4 cm) NFL vs. DHS 1.99 (95% CI: 1.15-3.44) 0.014 Data presented as mean (standard deviation) or number (percentage) unless otherwise stated. BSA, body surface area; DHS, Dallas Heart Study; HDL-C, high-density lipoprotein cholesterol; NFL, National Football League; SBP, systolic blood pressure. *Model adjusted for age, race, SBP, hypertension, diabetes, current smoking BSA, HDL-C, and non-HDL-C.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) ASCENDING AORTIC DIMENSIONS IN FORMER NATIONAL FOOTBALL LEAGUE ATHLETES Moderated Poster Contributions Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C Saturday, March 18, 2017, 12:30 p.m.-12:40 p.m. Session Title: Hearts and Soles: Multimodality Imaging in Athletes Abstract Category: 31. Non Invasive Imaging: Sports and Exercise Presentation Number: 1225M-03 Authors: James L. Gentry, David Carruthers, Christopher Maroules, Parag Joshi, Colby Ayers, Philip Aagaard, Rory Hachamovitch, Reginald Dunn, Andrew Lincoln, Andrew Tucker, Kezia Alexander, Dermot Phelan, Heart and Vascular Institute at the Cleveland Clinic, Cleveland, OH, USA, University of Texas Southwestern Medical Center, Dallas, TX, USA
Background: Ascending aortic dimensions are slightly larger in athletes compared to sedentary controls and almost rarely > 4 cm. It is unknown whether past exposure to the hemodynamic stress of repetitive strenuous exercise translates into differences in aortic dimensions in former elite athletes. Methods: This is a retrospective, cross-sectional study of 206 former National Football League (NFL) athletes compared with 759 male subjects from the Dallas Heart Study (DHS). Mid-ascending aortic dimensions were obtained from computed tomographic scans performed as part of a screening protocol (NFL) or as part of the DHS protocol. Results: Baseline characteristics are shown in the Table. Compared to a population based control, former NFL athletes had significantly larger ascending aortic diameters (3.8 ± 0.5 cm vs. 3.4 ± 0.4 cm; p< 0.0001). A significantly higher proportion of retired NFL players had an aorta of > 4 cm (29.6% versus 8.6%, p=<0.0001). After adjusting for age, race, body surface area, systolic blood pressure, history of hypertension, current smoking, and diabetes the former NFL players still had significantly larger aortas (Table). Former NFL players were twice as likely to have an aorta > 4 cm after adjusting for the same parameters (Table). Conclusions: Ascending aortic dimensions are significantly larger in former NFL athletes even accounting for their size, age, and risk factors. Whether this translates to an increased risk is unknown and requires further evaluation. Baseline Characteristics Age, years BSA, m2 SBP, mmHg Non-HDL-C, mg/dl HDL-C, mg/dl Aorta, cm African American Hypertension Diabetes Current Smoking Potentially Important Predictors of Aortic Size Unadjusted (n = 965) NFL vs. DHS Constant Adjusted (n = 932) NFL vs. DHS Age, years African American SBP, mmHg Hypertension Diabetes Current smoking BSA, m2 Constant Odds Ratio for having an Aortic Size > 4 cm
Table. Baseline characteristics of the study population and predictors of aortic size. DHS (n =759) 53.6 (8.3) 2.1 (0.2) 134.9 (18) 143.9 (41.4) 48.3 (13.4) 3.4 (0.4) 400 (52.7%) 416 (54.8%) 128 (16.9%) 196 (26.5%)
NFL (n = 206) 57.1 (10.3) 2.4 (0.2) 132 (15.6) 127.5 (37.9) 53.9 (14.9) 3.8 (0.5) 97 (47.1%) 76 (36.9%) 31 (15.1%) 18 (8.7%)
p-value < 0.0001 < 0.0001 0.163 < 0.0001 < 0.0001 < 0.0001 0.158 < 0.0001 0.597 < 0.0001
Unstandardized Coefficient
Standard Error
p-value
0.37 3.44
0.03 0.02
< 0.0001 < 0.0001
0.22 0.02 -0.05 0.002 0.07 -0.05 0.003 0.38 1.19
0.04 0.0002 0.03 0.001 0.03 0.04 0.03 0.06 0.20
< 0.0001 < 0.0001 0.053 0.030 0.022 0.183 0.918 < 0.0001 < 0.0001
Odds ratio p-value Unadjusted (n =126, aorta > 4 cm) NFL vs. DHS 4.49 (95% CI: 3.03 - 6.65) <0.0001 Adjusted (n=124, aorta > 4 cm) NFL vs. DHS 1.99 (95% CI: 1.15-3.44) 0.014 Data presented as mean (standard deviation) or number (percentage) unless otherwise stated. BSA, body surface area; DHS, Dallas Heart Study; HDL-C, high-density lipoprotein cholesterol; NFL, National Football League; SBP, systolic blood pressure. *Model adjusted for age, race, SBP, hypertension, diabetes, current smoking BSA, HDL-C, and non-HDL-C.