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Atrial chamber remodelling in healthy pre-adolescent athletes engaged in endurance sports: A study with a longitudinal design. The CHILD study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 223, 325-330 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Previous studies investigated the exercise-induced adaptation of left (LA) and right atrium (RA) in adults, but little is known about respective changes in the growing heart of children. We aimed to longitudinally investigate the effects of endurance training on biatrial remodelling in preadolescent athletes.

METHODS AND RESULTS: Ninety-four children (57 endurance athletes, 37 sedentary controls; mean age 10.8±0.2 and 10.2±0.2years, respectively) were evaluated at baseline and after 5months by ECG and by two-dimensional, three-dimensional (3D) and speckle-tracking echocardiography. Athletes were trained at least 10h/week. The resting heart rate was lower in athletes (p=0.046) and decreased further after training (p<0.0001). Neither athletes nor controls had ECG evidence for LA or RA enlargement. At baseline, indexed LA volumes did not differ between groups (p=0.14) but indexed RA dimensions were larger in athletes (p=0.007). After 5months, indexed LA volumes increased in athletes but not in controls (p<0.0001, p=0.29; respectively) while indexed RA volumes increased in both groups (p<0.0001, p=0.018; respectively). At the same time, slight differences in biatrial reservoir and contractile function were found either in athletes, as demonstrated by speckle-tracking echocardiography, but 3D-derived LA and RA ejection fraction remained stable in both groups.

CONCLUSION: Endurance training influences the growing heart of preadolescent athletes with an additive increase in biatrial size, suggesting that morphological adaptations can occur also in the early phases of the sports career. Training-induced remodelling was associated with a preserved biatrial function, supporting the hypothesis of a physiological remodelling.

Place, publisher, year, edition, pages
2016. Vol. 223, 325-330 p.
Keyword [en]
Speckle-tracking echocardiography, Atrial strain, Training, 3-dimensional echocardiography, Echocardiography, athlete's heart
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-127537DOI: 10.1016/j.ijcard.2016.08.231ISI: 000387036200102PubMedID: 27543703OAI: oai:DiVA.org:umu-127537DiVA: diva2:1046791
Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2017-05-19Bibliographically approved
In thesis
1. Atrial function and loading conditions in athletes
Open this publication in new window or tab >>Atrial function and loading conditions in athletes
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Intensive training is associated with hemodynamic changes that typically induce an enlargement of cardiac chamber. Despite LA dilatation in athletes has been interpreted as a benign adaptation, little evidence is available. The aim of this thesis is to demonstrate that LA size changes in response to alterations in loading conditions and to analyse atrial myocardial function in athletes through the application of novel echocardiographic techniques.

We found that top-level athletes exhibit a dynamic morphological and functional LA remodelling, induced by training, with an increase in reservoir and conduit volumes, but stable active volume. Training causes an increase in biatrial volumes which is accompanied by normal filling pressures and stiffness. These changes in atrial morphology are not associated with respective electrical changes. Extending the evidence from adult athletes to children, we found that training-induced atrial remodelling can occur in the early phases of the sports career and is associated with a preserved biatrial function. Finally, in a meta-analysis study of the available evidence we demonstrated that atrial function and size are not affected by aging.

In conclusions, athlete’s heart is characterized by a physiological biatrial enlargement. This adaptation occurs in close association with LV cavity enlargement, is dynamic and reversible. This increase in biatrial size is not intrinsically an expression of atrial dysfunction. Indeed, in athletes the atria are characterized by a preserved reservoir function, normal myocardial stiffness, and dynamic changes in response to different loading conditions.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2017. 100 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1898
Keyword
athlete's heart, training, exercise, speckle-tracking echocardiography, atrial strain, atrial deformation
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-134873 (URN)978-91-7601-715-9 (ISBN)
Public defence
2017-06-12, Hörsal D, Unod T9, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
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Available from: 2017-05-22 Created: 2017-05-15 Last updated: 2017-05-24Bibliographically approved

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Citation style
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