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Relationship of ventricular and atrial dilatation to valvular function in endurance athletes
  1. N H Prakken1,
  2. B K Velthuis1,
  3. A C Bosker1,
  4. A Mosterd2,3,4,
  5. A J Teske2,
  6. W P Mali1,
  7. M J Cramer3
  1. 1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  4. 4Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
  1. Correspondence to Dr N H Prakken, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; n.prakken{at}


Objective To establish cardiac magnetic resonance imaging (MRI) reference values for atrial adaptation to training in endurance athletes in comparison with matched non-athletes. In addition, to study the relationship of atrial size to ventricular and annular size and valvular function.

Design Cross-sectional study.

Participants 180 healthy individuals aged 18–39 years (41% women): 60 elite endurance athletes (exercising > 18 h/week), 60 regular endurance athletes (9–18 h/ week), and 60 age and gender matched non-athletes (exercising ≤3 h/week) underwent cardiac MRI. Quantitative atrial dimensions and volumes, indexed for body surface area (BSA), were compared with ventricular and annular dimensions. Regurgitant fractions of all four valves and peak velocities of mitral and tricuspid valves were also assessed.

Results BSA-corrected right and left atrial volumes and diameters were significantly larger for athletes compared with non-athletes (p<0.05–p<0.0005). Ventricular, annular and atrial ratios remained constant for all groups, suggesting balanced adaptation to exercise training. E/A ratios remained statistically unchanged in all groups. Regurgitant fractions of the four cardiac valves were all mild (≤15%) and not significantly different in athletes compared with non-athletes.

Conclusions Atrial remodelling in endurance athletes may be regarded as a balanced physiological adaptation to exercise training with preservation of valvular function.

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  • Competing interests None.

  • Ethics approval The study was approved by the Institutional Ethics Committee of the University Medical Center Utrecht.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.