Cardiac Remodeling in US Professional Basketball Players

Study Questions:

What echocardiographic findings are present among US professional basketball players?

Methods:

The policy of the National Basketball Association (NBA) mandates annual preseason stress echocardiograms for every player; the NBA has sanctioned Columbia University Medical Center to conduct annual health and safety reviews of these echocardiograms. In an observational study, echocardiograms were performed between December 2013 and December 2014 on players on the active NBA rosters for the 2013-14 and 2014-15 seasons. Data were analyzed from January to May 2015. Cardiac variables assessed included left ventricular (LV) size, mass, wall thickness, hypertrophy patterns, and systolic function; left atrial volume; and aortic root diameter. All dimensions were biometrically scaled.

Results:

Of 526 athletes included in the study, 406 (77.2%) were African American and 107 (20.3%) were white, with a mean age of 25.7 ± 4.3 years. Mean athlete height was 200.2 ± 8.8 cm, and mean body surface area was 2.38 ± 0.19 m2. LV size and mass were proportional to body size, extending to the uppermost biometrics of the cohort. LV hypertrophy was present in 144 athletes (27.4%). African American athletes had increased LV wall thickness (unadjusted mean, 11.2 mm; 95% confidence interval [CI], 11.1-11.3 mm) and LV mass (unadjusted mean, 106.3 g/m2; 95% CI, 104.6-108.0 g/m2) compared with white athletes for LV wall thickness (unadjusted mean, 10.5 mm; 95% CI, 10.3-10.7 mm; p < 0.001) and LV mass (unadjusted mean, 102.2 g/m2; 95% CI, 99.0-105.4 g/m2; p = 0.03). The maximal aortic root diameter in the cohort was 42 mm; aortic root diameters reached a plateau at the uppermost biometric variables. Five athletes (1.0%) had an LV ejection fraction <50%, and all ventricles augmented normally with exercise.

Conclusions:

This study provides normative cardiac data for a group of athletes with greater anthropometry than any previously studied athlete group and for a group known to have elevated rates of sudden cardiac death. The authors conclude that these data can be incorporated into clinical assessments for the primary prevention of cardiac emergencies in basketball players and the athletic community at large.

Perspective:

This is an interesting observation description of features of LV size, hypertrophy, and systolic function; and aortic size among US NBA players. The incidence of sudden cardiac death is higher in US basketball players compared with other athlete groups; however, the recognition of risk factors for sudden cardiac death among basketball players is challenging, in part because little has been known about athletic cardiac remodeling in these athletes or athletes of similarly increased size. In as much as the present study defines what is present, it does not determine what is associated with low or with higher risk among this relatively higher-risk group.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias, Echocardiography/Ultrasound, Exercise, Sports & Exercise and Imaging

Keywords: Athletes, Basketball, Body Surface Area, Death, Sudden, Cardiac, Diagnostic Imaging, Echocardiography, Exercise, Hypertrophy, Left Ventricular, Primary Prevention, Risk Factors, Systole


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