title: Gender influence on the adaptation of atrial performance to training.
abstract: BACKGROUND
  High-intensity training has been associated with atrial remodelling and arrhythmias in men. Our purpose was to analyse atrial performance in female endurance athletes, compared to male athletes and controls.
  
  
  METHODS
  This was a cross-sectional study. We included four groups: female athletes, females controls, male athletes and male controls. Left (LA) and right atrial (RA) volumes and function were assessed using 2D and speckle-tracking echocardiography to determine peak atrial strain-rate at atrial (SRa) and ventricular contraction (SRs), as surrogates of atrial contractile and reservoir function, respectively. ANOVA and Bonferroni's statistical tests were used to compare variables among groups.
  
  
  RESULTS
  We included 82 subjects, 39 women (19 endurance athletes, 20 controls) and 43 men (22 endurance athletes, 21 controls). Mean age was similar between groups (36.6 ± 5.6 years). Athletes had larger bi-atrial volumes, compared to controls (women, LA 27.1 vs. 15.8 ml/m2, p < 0.001; RA 22.31 vs. 14.2 ml/m2, p = 0.009; men, LA: 25.0 vs. 18.5 ml/m2, p = 0.003; RA 30.8 vs. 21.9 ml/m2, p < 0.001) and lower strain-rate (women, LASRa -1.60 vs. -2.18 s-1, p < 0.001; RASRa -1.89 vs. -2.38 s-1, p = 0.009; men, LASRa -1.21 vs. -1.44 s-1, p = 1; RASRa -1.44 vs. -1.60 s-1, p = 1). However, RA indexed size was lower and bi-atrial deformation greater in female athletes, compared to male athletes.
  
  
  CONCLUSIONS
  The atria of both male and female athletes shows specific remodelling, compared to sedentary subjects, with larger size and less deformation at rest, particularly for the RA. Despite a similar extent of remodelling, the pattern in women had greater bi-atrial myocardial deformation and smaller RA size.
authors.affiliation: a Cardiovascular Institute , Hospital Clinic, IDIBAPS, University of Barcelona , Barcelona , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Sanchis
authors.affiliation: a Cardiovascular Institute , Hospital Clinic, IDIBAPS, University of Barcelona , Barcelona , Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Sanz-de La Garza
authors.affiliation: b ICREA , Barcelona , Spain.|c Universitat Pompeu Fabra , Barcelona , Spain.
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: d Montreal Heart Institute , Montreal , Canada.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Giraldeau
authors.affiliation: a Cardiovascular Institute , Hospital Clinic, IDIBAPS, University of Barcelona , Barcelona , Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Grazioli
authors.affiliation: a Cardiovascular Institute , Hospital Clinic, IDIBAPS, University of Barcelona , Barcelona , Spain.
authors.forename: Josefa
authors.initials: J
authors.lastname: Marin
authors.affiliation: e Advanced Center for Chronic Diseases, Escuela de Medicina, Pontificia Universidad Católica de Chile , Santiago , Chile.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gabrielli
authors.affiliation: a Cardiovascular Institute , Hospital Clinic, IDIBAPS, University of Barcelona , Barcelona , Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Montserrat
authors.affiliation: a Cardiovascular Institute , Hospital Clinic, IDIBAPS, University of Barcelona , Barcelona , Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D056352:Athletes; D016275:Atrial Function / Q000502:physiology*; D064752:Atrial Remodeling; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004452:Echocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology; D006801:Humans; D008297:Male; D057185:Sedentary Behavior; D012737:Sex Factors
keywords: atrial fibrillation; atrial strain; endurance exercise; speckle-tracking echocardiography; women