Researchers release heart study that may limit cardiac risk for NBA players

Though the heart's left ventricle in NBA players is proportional to a player’s size, the aortic root does not continue to increase proportionately with height, which could pose a serious health risk, according to a vital study published in Wednesday’s inaugural edition of JAMA Cardiology.

In the process of the study, researchers produced data that can be “incorporated into clinical assessments for the primary prevention of cardiac emergencies,” according to the study.

“We’ve been able to create a database for every cardiac dimension that we follow clinically,” Dr. David J. Engel, the study’s lead author and cardiologist at New York-Presbyterian/Columbia University Medical Center, said. “We’ve been able to characterize the athlete’s heart in basketball players. This is the first time this has ever been done so the information that we’ve gathered will serve as a frame of reference for any health-care provider who takes care of basketball players at all skill levels and also for the athletic community in general.”

Researchers from Presbyterian/Columbia analyzed echocardiograms of 526 NBA players from the 2013-14 and 2014-15 seasons in collaboration with the NBA and National Basketball Players Association.

Though it was an independent study, the NBA played significant part. Since 2006, the league has taken echocardiogram and EKG images of players. The league believed it could do more and began working with the cardiology group at Presbyterian-Columbia.

Doctors created a detailed and standardized testing protocol. Teams uploaded those images to an electronic medical records system, and researchers then began analyzing results.

Researchers believe the study will help further identify and understand cardiac risk in basketball players, and other athletes, and will help shape prevention strategies.

Basketball players have the highest incidence of sports-related sudden cardiac death in the United States, according to researchers, but until now, there had not been significant studies on the hearts of basketball players or similar-sized athletes in the U.S.

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Among other important findings:

• NBA players with an aortic root – a part of the aorta – greater than 41 millimeters should be evaluated regardless of their height.
• An abnormally large aortic root may indicate a risk of sudden cardiac death or Marfan syndrome, a genetic disorder that affects the heart, eyes and circulatory system.
• Doctors now have a more accurate basis for assessing the risk of sudden cardiac death.

“We’ve established what normal values should be for every cardiac dimension based on height and body surface area and we can define what normal changes are for elite U.S. athletes,” Engel said.

The study also found that African-American players had “increased left ventricular wall thickness and mass compared with white athletes.”

“This is important for health-care providers who evaluate U.S. athletes because the hearts are different in terms of weight and geometry,” Engel said.

Prior to each preseason, the NBA requires players to undergo evaluations, including stress echocardiograms. Each player participating in the NBA’s draft combine in May undergoes similar testing.

That’s how Baylor’s Isaiah Austin discovered he had Marfan syndrome just before the 2014 draft. He was a projected late first- or second-round pick, but the diagnosis ended his basketball career.

It also potentially saved his life.

“It’s your health and basketball is just a sport,” Austin said Tuesday after returning home from his final class of the day in his final semester at Baylor. “I loved it with all my heart but I wanted to be able to live an elongated life with my family and friends.”

Disappointed at the time, Austin didn’t let the diagnosis define him and the end of basketball “wasn’t going to be the end of life,” he said.

It was the opposite. He travels the country for speaking events for his foundation, which provides support and awareness for Marfan syndrome, has a partnership with Haier and will graduate with a marketing degree sooner than he expected.

At the 2014 draft, Silver made Austin an honorary draft pick and offered him a job at the NBA, which Austin said he plans to take after he graduates.

“I really am thankful. It could have saved my life. I wasn’t willing to take that risk,” he said.

The researchers called the study a “considerable leap in the right direction," and the NBA will allow Presbyterian-Columbia to conduct yearly health and safety reviews of players' echocardiograms.

“The information that we have serves a reference to help distinguish a normal heart from an abnormal heart, which is important for player health and safety to identify people who may have an underlying cardiac problem that can pose a risk for sudden cardiac death,” Engel said. “But it also should help with unnecessary exclusions of athletes from competition because we now know what normal changes should be.”