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P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletes
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2016 (English)In: International Journal of Cardiac Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 32, no 3, 407-415 p.Article in journal (Refereed) Published
Abstract [en]

Biatrial enlargement is common in athletes with a further increase occurring after training. P-wave morphology seems to be unaffected by atrial size, however longitudinal data are not available. This study aimed to prospectively investigate whether exercise-induced increase in biatrial size corresponds to electrical changes on 12-lead ECG. Thirty-five athletes were evaluated at the beginning of the training and after 6 months by ECG and standard and speckle-tracking echocardiography. Twenty-three sedentary subjects served as controls. Athletes had greater left atrial (LA) and right atrial (RA) size compared with controls (20.7 ± 4.7 vs. 27.1 ± 6.6 and 17.3 ± 3.8 vs. 23.4 ± 6.3 mL/m2, respectively, p < 0.0001). After 6 months, a further increase in LA and RA size was observed (p < 0.0001 and p = 0.002, respectively). Neither athletes nor controls fulfilled the ECG criteria for RA enlargement and no differences were found for LA enlargement criteria between athletes and controls (2/35, 6 % vs. 0/23, 0 %, p = 0.23). This percentage remained unchanged after training. Biatrial stiffness remained normal in athletes also after training. Training causes an increase in biatrial volumes, with normal filling pressures and normal stiffness. These changes in atrial morphology are not associated with respective electrical changes, suggesting that P-wave morphology is unaffected by training-induced biatrial dilatation in young healthy athletes.

Place, publisher, year, edition, pages
2016. Vol. 32, no 3, 407-415 p.
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine, cardiovascular disease
Identifiers
URN: urn:nbn:se:umu:diva-112219DOI: 10.1007/s10554-015-0790-zISI: 000370166100005PubMedID: 26474571OAI: oai:DiVA.org:umu-112219DiVA: diva2:876537
Available from: 2015-12-04 Created: 2015-12-04 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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Citation style
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