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The impact of aging on left atrial size and function: a systematic review and meta-analysis in healthy subjects
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background. The cardiovascular system is affected by aging, however conflicting results cloud this relationship and data on LA myocardial function and aging are scanty. The aim of this study was to evaluate the impact of aging on LA size and function in healthy subjects.

Methods. We conducted a systematic literature search of MEDLINE database. We included only studies evaluating healthy subjects, with age ranged between 18 and 80 years. Parameters were compared among 4 age groups, <30, 30-45, >45-60, >60 years.

Results. Three hundred twenty-six studies met the inclusion criteria and the final population consisted of 62,821 subjects. LA antero-posterior diameter and LA volume gradually increased with aging, however LA volume index did not differ among groups. LA ejection fraction measured by three-dimensional echocardiography modestly reduced with age (p=0.049), but respective measurements derived by two-dimensional echocardiography did not (p=0.94). LA reservoir function, measured by strain, did not differ among the groups. Left ventricular (LV) size and function were not different among groups, except LV mass index. A decrease in E/A ratio and an increase in E/e’ ratio with advancing age (p<0.0001 and p=0.001, respectively).

Conclusions. In healthy subjects LA volume index is not influenced while LA antero-posterior diameter and absolute volumes increase with advancing age. Neither LA deformation nor systolic function measures were affected by age. Thus, an increase in LA volume index and a decrease in LA reservoir function should be considered as an expression of pathology rather than part of normal aging.

National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-135110OAI: oai:DiVA.org:umu-135110DiVA: diva2:1096739
Available from: 2017-05-18 Created: 2017-05-18 Last updated: 2017-05-19
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
Supervisors
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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