Exercise-Induced Atrial Remodeling in Female Amateur Marathon Runners Assessed by Three-Dimensional and Speckle Tracking Echocardiography

Abstract

Endurance athletes have an increased risk of atrial remodeling and atrial arrhythmias. However, data regarding atrial adaptation to physical exercise in non-elite athletes are limited. Even less is known about atrial performance in women. We aimed to elucidate exercise-induced changes in atrial morphology and function in female amateur marathon runners using three-dimensional (3D) echocardiography and two-dimensional (2D) speckle tracking echocardiography (STE). The study group consisted of 27 female (40 ± 7 years) amateur athletes. Right (RA) and left atrial (LA) measures were assessed three times: 2–3 weeks before the marathon (stage 1), immediately after the run (stage 2), and 2 weeks after the competition (stage 3). Directly after the marathon, a remarkable RA dilatation, as assessed by RA maximal volume (RAVmax, 31.3 ± 6.8 vs. 35.0 ± 7.0 ml/m2; p = 0.008), with concomitant increase in RA contractile function [RA active emptying fraction (RA active EF), 27.7 ± 8.6 vs. 35.0 ± 12.1%; p = 0.014; RA peak atrial contraction strain (RA PACS) 13.8 ± 1.8 vs. 15.6 ± 2.5%; p = 0.016] was noticed. There were no significant changes in LA volumes between stages, while LA active EF (34.3 ± 6.4 vs. 39.4 ± 8.6%; p = 0.020), along with LA PACS (12.8 ± 2.1 vs. 14.9 ± 2.7%; p = 0.002), increased post race. After the race, an increase in right ventricular (RV) dimensions (RV end-diastolic volume index, 48.8 ± 11.0 vs. 60.0 ± 11.1 ml/m2; p = 0.001) and a decrease in RV function (RV ejection fraction, 54.9 ± 6.3 vs. 49.1 ± 6.3%; p = 0.006) were observed. The magnitude of post-race RV dilatation was correlated with peak RA longitudinal strain deterioration (r = −0.56, p = 0.032). The measured parameters did not differ between stages 1 and 3. In female amateur athletes, apart from RV enlargement and dysfunction, marathon running promotes transient biatrial remodeling, with more pronounced changes in the RA. Post-race RA dilatation and increment of the active contraction force of both atria are observed. However, RA reservoir function diminishes in those with post-race RV dilation.

Long-Term Sports Practice and Atrial Fibrillation: An Updated Review of a Complex Relationship

“…A recent study conducted on female amateur marathon runners investigated the remodeling of the cardiac chambers induced by endurance training, which might be different from that of male athletes [95]. The authors [95] found that immediately after a marathon there was a significant, but reversible, dilation of both the right atrium and the right ventricle, accompanied by a decrease in the contractility of the right ventricle.…”

“…A recent study conducted on female amateur marathon runners investigated the remodeling of the cardiac chambers induced by endurance training, which might be different from that of male athletes [95]. The authors [95] found that immediately after a marathon there was a significant, but reversible, dilation of both the right atrium and the right ventricle, accompanied by a decrease in the contractility of the right ventricle. In contrast, the left heart chambers were less affected by acute remodeling: the size of the left ventricle had decreased after the race and no significant reduction in the size of the left atrium was observed.…”

Effects of acromegaly treatment on left ventricular systolic function assessed by speckle tracking echocardiography in relation to sex differences: results from a prospective single center study

“…It is difficult to explain such changes only by an increase in the afterload. Some similarities can be found with an athlete’s heart in which atrial remodeling is a physiological adaptation to volume overload allowing for greater volume delivery and increased cardiac output ( 42 ).…”

May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review

“…In summary, discrepancies exist among different studies concerning the acute effects of intense exercise on atrial function. Even if prolonged exercise can cause acute atrial dysfunction, preliminary evidence suggests that this is a transient and reversible effect [ 20 ].…”