Phil Blake

Male rugby players have an “alarming” prevalence of ascending aorta dilatation and abnormal anterior effacement that warrants ongoing surveillance, cardiologists say.

The Australian study was prompted by an incidental finding in former rugby league player and rugby union coach Phil Blake.

The study of 152 retired and current elite level male rugby players found aortic root and ascending aorta dimensions were significantly higher than expected in a normal population or other athletes.

The men were mostly Caucasian (91%) with an average age of 45 years, 13.4 years of playing competitively, and training hours of 23.4 hours per week.

All men were asymptomatic and screened with transthoracic echocardiography.

The research team, including cardiologist Professor David Celermajer of the University of Sydney, found all players had normal aortic valve morphology and function.

While clinically significant aortic dilatation is typically rare, 41% of the study group were found to have an aortic root ≥ 40 mm.

Abnormal anterior effacement at the sinotubular junction was present in 88 players (58%).

“Players with abnormal anterior effacement were significantly more likely to have aortic root dilatation (mean 2.3mm larger, 95% CI 1.1–3.4, p<0.01) and ascending aortic dilatation (mean 2.9mm larger, 95% CI 1.6–4.2, p<0.01),” the study said.

The study found a longer duration of competitive participation ≥ 15 years was associated with aortic root size >40 mm (OR 2.7, 95% CI 1.3–5.4, p<0.01). Ascending aorta Z-score >2 was associated with non-Caucasian ethnicity only (OR 13.1, 95% CI 1.7–103.7, p<0.01). Abnormal anterior aortic effacement was only associated with playing rugby at an elite level.

Dr Sharon Kay, a cardiac physiologist at Royal North Shore Hospital, told the limbic the clinical implications of their findings were still unclear.

“We don’t know what it means because it will only be five years follow-up from the end of this year; so if they get bigger over time, if age is accelerating the problem, then it is something we have to watch.”

However she recommended retired rugby league and rugby union players ask their GP for a referral for an echo to check the size of their aorta.

“At this stage we don’t know whether either code is worse. We don’t know which player positions are worse. We do know it’s to do with the higher level they play and the longer they play.”

Men found to have dilated aortas would need cardiology consultations, yearly surveillance with repeat echos and probably a CT or MRI at a critical point.

She said current players should follow the screening program of their rugby code.

While Australian players were not routinely screened by echo, it was applied in some European countries including France and Italy.