Left atrial volume index in highly trained athletes

doi:10.1016/j.ahj.2010.03.036

American Heart Journal

Volume 159, Issue 6, June 2010, Pages 1155-1161

https://doi.org/10.1016/j.ahj.2010.03.036 Get rights and content

Background

Increase of left atrial (LA) diameter in trained athletes has been regarded as another component of the “athlete's heart”.

Aims

To evaluate the possible impact of competitive training on LA volume and to define reference values of LA volume index in athletes.

Methods and Results

Six hundred fifteen consecutive elite athletes (370 endurance- [ATE] vs 245 strength-trained athletes [ATS]; 385 men; 28.4 ± 10.2 years, range 18-40 years) underwent a comprehensive transthoracic echocardiography exam. LA maximal volume was measured at the point of mitral valve opening using the biplane area-length method, and corrected for body surface area. LA mild dilatation was defined as a LA volume index between 29 and 33 mL/m², while a moderate dilatation was identified by a LA volume index ≥34 mL/m². Left ventricular (LV) mass index and ejection fraction did not significantly differ between the 2 groups. Conversely, ATS showed increased body surface area, sum of wall thickness (septum + LV posterior wall), LV circumferential end-systolic stress (ESSc) and relative wall thickness, whereas LA volume index, LV stroke volume and LV end-diastolic volume were greater in ATE. The range of LA volume index was 26 to 36 mL/m² (mean 28.2 ± 9.2) in men and 22 to 33 mL/m² (mean 26.5 ± 7.2) in women (P < .01). LA volume index was mildly enlarged in 150 athletes (24.3%) and moderately enlarged only in 20, all males (3.2%). Mild mitral regurgitation was observed in 64 athletes (10.3%). LA volume index was significantly greater in ATE (P < .01). By multivariate analysis, the overall population type (P < .01) and duration (P < .01) of training and LV end-diastolic volume (P < .001) were the only independent predictors of LA volume index.

Conclusions

In a large population of highly trained athletes, a mild enlargement of LA volume index was relatively common and may be regarded as a physiologic adaptation to exercise conditioning.

Section snippets

Study population

From June 2008 to April 2009, 615 consecutive elite athletes were referred to the Sports Medicine Ambulatory service of Monaldi Hospital (Naples, Italy) for cardiovascular pre-participation screening⁸ and, afterwards, to our echocardiographic laboratory for the purpose of the present study. All subjects underwent a detailed history, physical examination, electrocardiography, chest radiography, ergometric electrocardiogram test and comprehensive transthoracic echocardiography (TTE), including

Results

Clinical characteristics of the study population are described in Table I. Mean age was comparable between the two groups. In accordance with the effects of different training protocols, ATS at rest showed higher heart rate, BSA and systolic blood pressure than ATE.

Discussion

Two-dimensional echocardiography is currently used to evaluate LA morphology and dimension.⁷ Pelliccia et al⁶ for the first time studied the prevalence and the clinical significance of LA enlargement in competitive athletes. They reported a mild increase of LA diameter (≥40 mm) in 18% of athletes, a marked dilatation (≥45 mm) in 2%, and a close association between LA diameter and LV cavity dimension. This morphological change was significantly influenced by the type of sport, with cycling,

Conclusions

LA enlargement is relatively common in top level athletes. LA volume index was significantly greater in elite endurance-trained athletes compared with age- and sex-matched strength athletes. According to our results, the upper limits of LA volume in competitive athletes were 33 mL/m² in women and 36 mL/m² in men. In the present study, we propose such LA volume reference values that can be useful in evaluation of LA enlargement to distinguish a physiological condition of “athlete's heart” from

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Malaysian athletes have thicker wall and bigger left ventricle than controls. No athletes have IVSd > 1.2 cm and/or LVIDd > 5.8 cm. There is no difference in GLS, RVFWS and GCS but athletes have smaller LArS and LAbS.
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Existe poca información sobre la dilatación de la aurícula izquierda (AI) y los parámetros electrocardiográficos en deportistas.
Estudio observacional multicéntrico en deportistas de competición y controles. La dilatación de la AI se definió como un volumen indexado por área de superficie corporal ≥ 34 ml/m². Se estudió su relación con parámetros electrocardiográficos auriculares.
Se incluyó en total a 356 sujetos: 308 deportistas de competición (media de edad, 36,4 ± 11,6 años) y 48 controles (49,3 ± 16,1 años). Los deportistas de competición tenían un mayor volumen medio indexado de la AI (29,8 ± 8,6 frente a 25,6 ± 8,0 ml/m²; p = 0,006) y una mayor prevalencia de dilatación de la AI (113 [36,7%] frente a 5 [10,4%]; p < 0,001), sin diferencias relevantes en cuanto a la duración de la onda P (106,3 ± 12,5 frente a 108,2 ± 7,7 ms; p = 0,31), la prevalencia de bloqueo interauricular (40 [13,0%] frente a 4 [8,3%]; p = 0,36) ni la puntuación Morphology-Voltage-P-wave duration (1,8 ± 0,84 frente a 1,5 ± 0,8; p = 0,71). El entrenamiento competitivo se asoció de manera independiente con la dilatación de la AI (OR = 14,7; IC95%, 4,7-44,0; p < 0,001), pero no con la duración de la onda P (OR = 1,02; IC95%, 0,99-1,04), el bloqueo interauricular (OR = 1,4; IC95%, 0,7-3,1) o la puntuación Morphology-Voltage-P-wave duration (OR = 1,4; IC95%, 0,9-2,2).
La dilatación de la AI es frecuente en deportistas de competición, pero no se acompaña de una modificación relevante en los parámetros electrocardiográficos.
There are scarce data on left atrial (LA) enlargement and electrophysiological features in athletes.
Multicenter observational study in competitive athletes and controls. LA enlargement was defined as LA volume indexed to body surface area ≥ 34 mL/m². We analyzed its relationship with atrial electrocardiography parameters.
We included 356 participants, 308 athletes (mean age: 36.4 ± 11.6 years) and 48 controls (mean age: 49.3 ± 16.1 years). Compared with controls, athletes had a higher mean LA volume index (29.8 ± 8.6 vs 25.6 ± 8.0 mL/m², P = .006) and a higher prevalence of LA enlargement (113 [36.7%] vs 5 [10.4%], P < .001), but there were no relevant differences in P-wave duration (106.3 ± 12.5 ms vs 108.2 ± 7.7 ms; P = .31), the prevalence of interatrial block (40 [13.0%] vs 4 [8.3%]; P = .36), or morphology-voltage-P-wave duration score (1.8 ± 0.84 vs 1.5 ± 0.8; P = .71). Competitive training was independently associated with LA enlargement (OR, 14.7; 95%CI, 4.7-44.0; P < .001) but not with P-wave duration (OR, 1.02; 95%CI, 0.99-1.04), IAB (OR, 1.4; 95%CI, 0.7-3.1), or with morphology-voltage-P-wave duration score (OR, 1.4; 95%CI, 0.9-2.2).
LA enlargement is common in adult competitive athletes but is not accompanied by a significant modification in electrocardiographic parameters.

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Clinical InvestigationImaging and Diagnostic TestingLeft atrial volume index in highly trained athletes

Background

Aims

Methods and Results

Conclusions

Section snippets

Study population

Results

Discussion

Conclusions

J Am Coll Cardiol

Am J Cardiol

Int J Cardiol

Int J Cardiol

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J Am Coll Cardiol

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Am J Cardiol

Am J Cardiol

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Clinical Investigation
Imaging and Diagnostic Testing
Left atrial volume index in highly trained athletes