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Training-induced dynamic changes in left atrial reservoir, conduit, and active volumes in professional soccer players
Siena, Italy.
Rome, Italy.
Siena, Italy.
Siena, Italy.
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2015 (English)In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 115, no 8, 1715-1723 p.Article in journal (Refereed) Published
Abstract [en]

Although left atrial (LA) enlargement is a recognized component of athlete's heart, dynamic cavity changes occurring during the training period remain to be elucidated. We aimed to investigate the adaptive changes of LA reservoir, conduit, and active volumes in elite athletes vs. controls and their response to different training loads. LA maximum, pre-P, and minimum volumes were assessed in 26 top-level athletes and 23 controls. In athletes, LA volumes were measured at pre-, mid-, end-training, and post-detraining time points using conventional 2D echocardiography. Athletes had larger maximum (27.5 +/- A 3.2 vs. 20.3 +/- A 5.8 mL/m(2), p = 0.001), pre-P (11.5 +/- A 0.9 vs. 9.8 +/- A 2.2 mL/m(2), p = 0.001), and minimum (6.6 +/- A 0.9 vs. 5.0 +/- A 1.2 mL/m(2), p < 0.001) LA indexed volumes, compared with controls. Total and passive emptying volume indices were also larger in athletes compared with controls (18.7 +/- A 3.1 vs. 15.3 +/- A 4.9 mL/m(2), p < 0.05 and 13.8 +/- A 2.9 vs. 10.5 +/- A 4.6 mL/m(2), p < 0.05, respectively), while active emptying volume was similar (p = 0.74). During training, LA maximum (p < 0.0001), pre-P (p < 0.0001), minimum (p < 0.0001), total (p < 0.005), and passive (p < 0.05) emptying volume indices progressively increased, while active emptying volume (p = 0.10) and E/e' ratio (p = 0.32) remained unchanged. After detraining, LA volume measurements were not different from pre-training ones. End-training left ventricular mass index was the only independent predictor of the respective maximum LA volume (beta = 0.74, p < 0.005). Top-level athletes exhibit a dynamic morphological and functional LA remodeling, induced by training, with an increase in reservoir and conduit volumes, but stable active volume. LA remodeling is closely associated with left ventricular adaptation to exercise and both completely regress after detraining.

Place, publisher, year, edition, pages
Springer, 2015. Vol. 115, no 8, 1715-1723 p.
Keyword [en]
Athlete's heart, Exercise, Training, Atrial function, Atrial remodeling, Phasic volumes
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine, cardiovascular disease
Identifiers
URN: urn:nbn:se:umu:diva-106766DOI: 10.1007/s00421-015-3151-7ISI: 000358026000011PubMedID: 25808863OAI: oai:DiVA.org:umu-106766DiVA: diva2:847500
Available from: 2015-08-20 Created: 2015-08-07 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
Supervisors
Available from: 2017-05-22 Created: 2017-05-15 Last updated: 2017-05-24Bibliographically approved

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Henein, Michael

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