title: Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete's heart.
abstract: Left atrial (LA) fibrosis with increased stiffness has been assumed to be the substrates for occurrence of atrial arrhythmias in athletes. However, this hypothesis has not yet been confirmed in humans. Aim of this study was, therefore, to assess LA remodeling and stiffness in competitive athletes. 150 competitive athletes and 90 age and sex-matched sedentary subjects were analyzed by speckle-tracking echocardiography to measure peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS). LA stiffness was determined using E/e' ratio in conjunction with PALS. Left ventricular (LV) stiffness was also calculated. LA volume index was greater in athletes as compared with controls (24.6 ± 7.3 vs. 18.4 ± 7.8 mL/m(2), p < .0001). LA PALS, LA PACS, and E/e' ratio were lower in athletes in comparison with controls (p < .05, p ≤ .001, and p < .0001, respectively). Despite greater LA size, competitive athletes had lower LA stiffness as compared with controls (0.13 ± 0.04 vs. 0.16 ± 0.06, p ≤ .001). In addition, LV stiffness was lower in athletes (0.84 ± 0.27 vs. 1.07 ± 0.46, p ≤ .001). The only independent predictor of LA stiffness was LV stiffness (β = 0.46, p < .0001), while the only independent predictor of LA volume index was LV end-systolic volume index (β = 0.25, p = .002). Competitive athletes showed greater LA size associated with lower stiffness as compared with controls. Thus, LA remodeling in the context of the athlete's heart is not associated with increased LA stiffness. These findings support the benign nature of LA remodeling in athletes, occurring as a physiological adaptation to exercise conditioning.
authors: Department of Cardiovascular Diseases, University of Siena, Viale M. Bracci, 16 53100, Siena, Italy, flavio.dascenzi@libero.it.
authors: Flavio
authors: F
authors: D'Ascenzi
authors: Antonio
authors: A
authors: Pelliccia
authors: Benedetta Maria
authors: BM
authors: Natali
authors: Matteo
authors: M
authors: Cameli
authors: Valentina
authors: V
authors: Andrei
authors: Eufemia
authors: E
authors: Incampo
authors: Federico
authors: F
authors: Alvino
authors: Matteo
authors: M
authors: Lisi
authors: Margherita
authors: M
authors: Padeletti
authors: Marta
authors: M
authors: Focardi
authors: Marco
authors: M
authors: Bonifazi
authors: Sergio
authors: S
authors: Mondillo
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D059267:Cardiomegaly, Exercise-Induced; D016022:Case-Control Studies; D018619:Echocardiography, Doppler, Pulsed; D004548:Elasticity; D015444:Exercise / Q000502:physiology*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D057185:Sedentary Behavior; D013314:Stress, Mechanical; D016277:Ventricular Function, Left; D055815:Young Adult
references: Circ Cardiovasc Imaging. 2014 Mar;7(2):222-9
references: 24470314
references: Nutrition. 1989 Sep-Oct;5(5):303-11; discussion 312-3
references: 2520314
references: Int J Sports Med. 2013 May;34(5):379-84
references: 23041967
references: Circ Cardiovasc Imaging. 2009 Mar;2(2):93-9
references: 19808574
references: Eur J Prev Cardiol. 2014 Aug;21(8):1040-8
references: 23610454
references: G Ital Cardiol (Rome). 2010 Oct;11(10 Suppl 1):102S-106S
references: 21416837
references: Echocardiography. 2011 Mar;28(3):320-6
references: 21366689
references: J Am Coll Cardiol. 2007 May 15;49(19):1903-14
references: 17498573
references: Circ Cardiovasc Imaging. 2010 May;3(3):231-9
references: 20133512
references: Korean Circ J. 2012 May;42(5):311-8
references: 22701133
references: Circulation. 2000 Oct 10;102(15):1788-94
references: 11023933
references: Am J Physiol. 1992 May;262(5 Pt 2):H1356-60
references: 1590438
references: Am Heart J. 2010 Jun;159(6):1155-61
references: 20569734
references: Circulation. 2007 Aug 7;116(6):637-47
references: 17646587
references: Eur J Echocardiogr. 2011 Nov;12 (11):826-33
references: 21880608
references: Cardiovasc Ultrasound. 2012 Dec 03;10 :48
references: 23199055
references: Am J Med. 1964 Jul;37:36-43
references: 14181147
references: Echocardiography. 2012 Sep;29(8):943-9
references: 22954405
references: Eur J Echocardiogr. 2006 Mar;7(2):79-108
references: 16458610
references: Eur J Echocardiogr. 2009 Mar;10 (2):165-93
references: 19270053
references: Heart. 2008 Oct;94(10):1323-5
references: 18474535
references: Int J Sports Med. 2012 Oct;33(10 ):795-801
references: 22562745
references: Circ Res. 1982 Aug;51(2):205-15
references: 7094230
references: Br J Sports Med. 2012 Nov;46 Suppl 1:i37-43
references: 23097477
references: Circ Cardiovasc Imaging. 2009 Jan;2(1):10-5
references: 19808559
references: Circ Arrhythm Electrophysiol. 2013 Apr;6(2):252-6
references: 23515264
references: J Am Coll Cardiol. 2002 Nov 6;40(9):1630-5
references: 12427416
references: J Cardiovasc Electrophysiol. 2011 Sep;22(9):999-1006
references: 21457382
references: J Cardiovasc Ultrasound. 2012 Sep;20(3):140-5
references: 23185657
references: Am J Cardiol. 2008 Jun 1;101(11):1626-9
references: 18489941
references: Echocardiography. 2011 Mar;28(3):276-87
references: 20868439
references: Circulation. 2011 Jan 4;123(1):13-22
references: 21173356
references: J Am Coll Cardiol. 2013 Jul 2;62(1):68-77
references: 23583240
references: Europace. 2009 Jan;11(1):11-7
references: 18988654
references: Circ Res. 1974 Jul;35(1):39-43
references: 4841251
references: J Am Coll Cardiol. 2005 Aug 16;46(4):690-6
references: 16098437
references: J Am Soc Echocardiogr. 2010 May;23 (5):538-44
references: 20226627
references: J Am Soc Echocardiogr. 2010 Dec;23 (12 ):1251-8
references: 20970306
references: JAMA. 2014 Feb 5;311(5):498-506
references: 24496537