Serial multimodality assessment distinguished physiologic adaptation from maladaptive volume overload in 2 elite athletes with bicuspid aortic valves and moderate aortic regurgitation.
Case Report (n=2)
Serial multimodality assessment integrating symptoms, imaging, and exercise testing is valuable to distinguish physiologic from maladaptive volume overload in athletes with aortic regurgitation.
BACKGROUND: Distinguishing left ventricular (LV) remodeling due to early decompensation from chronic aortic regurgitation (AR) from physiologic adaptation to intensive endurance training is challenging. CASE SUMMARY: Two elite endurance athletes (and best friends) presented with bicuspid aortic valves complicated by moderate AR and marked LV remodeling. Despite near-identical valvular findings, LV volumes, and exceptional cardiorespiratory fitness at baseline, their clinical courses diverged. One developed exertional symptoms and underwent a Ross procedure, followed by rapid and profound reverse remodeling. The other remained asymptomatic with stable LV dimensions and supranormal exercise capacity on serial follow-up. Exercise imaging in the conservatively managed athlete demonstrated preserved contractile reserve and reduced AR during stress, consistent with compensated physiology. TAKE-HOME MESSAGE: These contrasting trajectories highlight the value of serial, multimodality assessment-integrating symptoms, imaging, stress testing and cardiopulmonary exercise testing-to distinguish physiologic from maladaptive volume overload and to guide timing of intervention in athletes with AR.
Trytell et al. (Wed,) conducted a case report in Bicuspid aortic valve with moderate aortic regurgitation (n=2). Serial multimodality assessment was evaluated. Serial multimodality assessment distinguished physiologic adaptation from maladaptive volume overload in 2 elite athletes with bicuspid aortic valves and moderate aortic regurgitation.