Elite athletes have larger absolute aortic sinus of Valsalva diameters than non-athlete healthy controlsElite Athletes Show Larger Aortic Diameters Than Non-Athlete Controls

European journal of preventive cardiology Published June 9, 2026 Study authors: Carbone Andreina, Monda Emanuele, Ferrara Francesco, Franzese Monica, Bottino Roberta, Russo Valenti… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that elite athletes have larger absolute AoSV, but no difference exists when adjusted for body surface area.

This meta-analysis synthesized data from 21 studies involving 9,464 elite athletes and 2,637 non-athlete healthy controls to evaluate echocardiographic aortic diameters at the sinus of Valsalva (AoSV). The analysis focused on absolute AoSV, as well as indices for height (AoSV/h) and body surface area (AoSV/BSA).

The meta-analysis found that elite athletes had significantly larger absolute AoSV compared to non-athlete controls (MD 1.69 mm; 95% CI 1.01-2.37, P < 0.001). While the difference remained significant when indexed to height (MD 0.04 mm/m; effect size 2.18, P < 0.001), no statistically significant differences were found between groups when AoSV was indexed to body surface area (MD 0.04 mm/m2, P = 0.880).

A noted limitation of the analysis is the paucity of studies for analyzing AoSV/h according to sex. Clinicians should note that while absolute aortic dimensions are larger in athletes, these differences disappear when indexed to body surface area. Proper normalization is essential during clinical evaluations to avoid misdiagnosing aortopathies in athletes.

A large review of 21 different studies looked at the heart health of over 9,000 elite athletes compared to about 2,600 healthy people who were not athletes. The researchers specifically measured the diameter of the aorta, which is the main artery carrying blood from the heart.

The results showed that elite athletes had larger absolute measurements for this artery than non-athletes. However, when the researchers adjusted those numbers based on the athlete's body surface area, the difference between the two groups disappeared. This means the size of the artery was related to the person's overall size rather than just their athletic status.

Because these differences can disappear when properly calculated, doctors should use specific methods when measuring heart health in athletes. This helps ensure that a larger artery is correctly identified as a result of body size rather than a medical condition. These findings are helpful for ensuring accurate diagnoses in high-level sports.

What this means for you:

Elite athletes have larger absolute aortic diameters, but this difference disappears when adjusted for body size.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID39590649

View Original Abstract ↓

AIMS: To assess the presence and the extent of an 'aortic remodelling' in elite athletes. METHODS AND RESULTS: A systematic review and meta-analysis of literature were conducted for studies (1981-2024) reporting echocardiographic aortic diameters of elite athletes compared with non-athlete healthy controls. Among the 5494 studies retrieved, 21 (9464 elite athletes vs. 2637 non-athlete controls) fulfilled all eligibility criteria. Data were aggregated using a random-effects model for estimating the pooled risk ratio and mean difference (MD). Absolute aortic diameters at the sinus of Valsalva (AoSV) were higher in overall elite athletes compared with non-athlete healthy controls {MD 1.69 [95% confidence interval (CI) 1.01-2.37] mm; P < 0.001} and if stratified to sex. This difference was maintained if AoSV was indexed to height (AoSV/h) [MD 0.04 (95% CI -0.00-0.08) mm/m; effect size 2.18 (95% CI 1.10-3.26); P < 0.001]. The analysis of AoSV/h according to sex was not performed for the paucity of studies. However, when indexed to body surface area (AoSV/BSA), no differences were found between the two groups [MD 0.04 (95% CI -0.25-0.34) mm/m2; P = 0.880], also according to sex. Above findings were not influenced by age. CONCLUSION: Absolute AoSV was mildly larger in athletes compared with non-athlete healthy controls, even when indexed to height. However, no differences were evident when indexed by BSA, irrespective of sex, type of sport, and age. Therefore, assessment of the aortic size in elite athletes should consider the proper normalization in order to avoid misdiagnosis of aortopathies. REGISTRATION: PROSPERO: CRD42024561255. LAY SUMMARY: Aortic diameters evaluation in athletes represents an important topic in cardiology and the knowledge about the aortic remodelling driven by intense exercise would allow for the correct management of athletes by differentiating those with pathologic enlargement from those with physiologic adaptation.This comprehensive meta-analysis highlights mildly larger absolute aortic diameters at the sinus of Valsalva diameters in elite athletes compared with non-athlete healthy controls, even when indexed to height. However, no differences were evident when indexed by body surface area, irrespective of sex, type of sport, and age.Assessment of the aortic size in elite athletes should consider the proper normalization in order to avoid misdiagnosis of aortopathies.

Elite athletes have larger absolute aortic sinus of Valsalva diameters than non-athlete healthy controlsElite Athletes Show Larger Aortic Diameters Than Non-Athlete Controls

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Elite athletes have larger absolute aortic sinus of Valsalva diameters than non-athlete healthy controlsElite Athletes Show Larger Aortic Diameters Than Non-Athlete Controls

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