Atrial functional and geometrical remodeling in highly trained male athletes: for better or worse?

Gabrielli, Luigi; Bijnens, Bart; Butakoff, Constantine; Duchateau, Nicolás; Montserrat, Sílvia; Merino, Beatriz; Gutiérrez, Javier Franch; Paré, Carles; Mont, Lluís; Brugada, Josep; Sitges, Marta

doi:10.1007/s00421-014-2845-6

Cited by 43 publications

(58 citation statements)

References 29 publications

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“…In our study, the functional assessment of LA was feasible in nearly all examined athletes. The important information is that LA STE derived strain was independent of LA size, which had been postulated before based on smaller sample groups (N < 25) (D'Ascenzi et al, 2012; Gabrielli et al, 2014). LA systolic and diastolic strains in young athletes are also independent of the parameters of left ventricular hypertrophy and left ventricle filling pressure.…”

Section: Discussionmentioning

confidence: 61%

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Król

Jedrzejewska

Konopka

et al. 2016

Journal of Human Kinetics

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Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women). All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001). Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%). We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

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Section: Discussionmentioning

confidence: 61%

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Król

Jedrzejewska

Konopka

et al. 2016

Journal of Human Kinetics

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“…Four studies published by D'Ascenzi et al and two studies by Gabrielli et al had different aims and, more importantly, population samples.…”

Section: Resultsmentioning

confidence: 99%

Left atrial volume in elite athletes: A meta‐analysis of echocardiographic studies

Cuspidi

Sala

Tadić

et al. 2019

Scandinavian Med Sci Sports

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Aim Information on left atrium (LA) enlargement, as assessed by LA volume (LAV) instead of LA diameter, in the athletic population is scanty. To expand current knowledge on this issue, we performed an updated meta‐analysis of echocardiographic studies. Design The Ovid MEDLINE, PubMed, and Cochrane CENTRAL databases were searched for English language articles without time restriction up to February 2018 through focused, high sensitive search strategies. Studies were identified by crossing the following search terms: “athletes,” “physical training,” “left atrial size,” “left atrial volume,” “atrial function,” and “echocardiography.”. Results Overall, 3145 subjects (2425 elite athletes and 720 active but not trained healthy controls) were included in 16 studies. Average LAV indexed to BSA (LAVI) was 37% higher in athletes as compared to nonathletic controls (31.0 ± 1.4 mL/m2 vs 22.2 ± 0.9 mL/m2), the standard means difference (SMD) being 1.12 ± 0.13 (CI: 0.86‐1.89, P < 0.0001). SMD was higher in high‐dynamic/high‐static trained athletes (1.78 ± 0.24, CI: 1.30‐2.20, P < 0.001) than in high‐dynamic/low‐static trained athletes 1.00 ± 0.16, CI: 0.70‐1.30, P < 0.001). The statistical difference did not change after correction for publication bias and was not affected by a single study effect. Conclusions Our meta‐analysis suggests that the adaptation of LA to intensive physical training in elite athletes is characterized by a marked increase in LAVI; LA dilation is more pronounced in the subgroup of high‐dynamic/high‐static trained athletes. The functional and clinical implications related to advanced LA dilation in athletes and particularly in those engaged in high‐dynamic/high‐static disciplines deserve further investigations.

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“…While both disease and training may produce atrial enlargement, strain may aid in differentiating between pathological and physiological remodeling; in atrial fibrillation (Kuppahally et al 2010) and other pathologies associated with atrial enlargement, peak atrial strain is depressed (Mondillo et al 2011). A recent study found that while a majority of endurance athletes had LA strains similar to controls, a subgroup was characterized by impaired strain, and suggested that this subgroup may operate at higher LA wall stress (Gabrielli et al 2014). Conversely, our data and others have demonstrated enhanced or preserved atrial strain following both short-and long-term endurance training (Gabrielli et al 2012), while LA strain is depressed in patients with hypertrophic cardiomyopathy (Gabrielli et al 2012).…”

Section: Myocardial Deformation Mechanicsmentioning

confidence: 96%

Left atrial functional changes following short-term exercise training

et al. 2014

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Atrial functional and geometrical remodeling in highly trained male athletes: for better or worse?

Abstract: A proportion of athletes with enlarged LA and RA showed different atrial contractile performance, likely resulting in atria working at higher wall stress.

Cited by 43 publications

References 29 publications

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Left atrial volume in elite athletes: A meta‐analysis of echocardiographic studies

Left atrial functional changes following short-term exercise training

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