u/DadDeen

• I am an 57-year-old male, 73kg. I have been commuting to work cycling 20km on most weekdays for the last 12 years and running parkuns on the weekend. I only recently taken up long-distance running, completing a few marathons in the last 18 months.
• Interestingly, I only started long-distance running after the first indications of valve disease were found. An echocardiogram was performed after a routine ECG flagged an abnormality. The tests results were misplaced, and I took it as a clean chit of health. Despite the diagnosis, my performance has been stable/improving, with a consistent age-graded Parkrun average (approx. 53-56%) over the last 8 years.
• Current Status: Completely asymptomatic. Stable $VO_2$ max (43-46).
• Diagnosis: Severe eccentric Aortic Regurgitation (AR) per TOE; Moderate AR (34% fraction) per MRI.
• Valve: Tricuspid; TOE shows "bending" of the right coronary cusp (RCC) and benign Lambl excrescences.
• LV Size (The Dilemma): * LVEDV (Volume): 232 mL ($122~ml/m^2$) — Dilated.
  • LVIDd (Diameter): 4.9 cm — Normal/Borderline.
  • LVESD (Diameter): 3.0 cm — Normal.
• LV Function: LVEF 59% (MRI) / 77% (Echo) — Preserved.
• Tissue Health: MRI confirmed no fibrosis, scarring, or infarction.
• Biomarkers: NT-BNP is currently undetectable.
• Aorta: Mildly dilated aortic root (42 mm).

My consultant has recommended immediate surgery because the AR is classified as "severe" and the ventricle is dilated. However, the MRI report notes the degree of dilatation "appears out of proportion to the AR" and likely reflects superimposed athletic remodeling from my cycling and running.

Because I am asymptomatic and my performance metrics are flat/stable, I’ve opted for "Careful Watchful Waiting" with a 6-month surveillance plan:

1. Monthly private NT-BNP tests to watch for any "silent" strain.
2. Rigorous tracking of smart-device metrics ($VO_2$ max, resting HR, race times).
3. Repeat Echo in October 2026.

I would love some feedback

1. Has anyone else with "Severe" AR and a "Dilated" LV been told it might just be "Athlete's Heart"? How did your team differentiate the two?
2. For the runners/cyclists: Did you find that your performance (pace/stamina) dropped before you noticed clinical symptoms like breathlessness?
3. If you chose surveillance, what were your specific "triggers" for finally deciding to go for the surgery?
4. Is anyone else using monthly NT-BNP as a primary monitoring tool while staying highly active?