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Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete’s heart

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Abstract

Left atrial (LA) fibrosis with increased stiffness has been assumed to be the substrates for occurrence of atrial arrhythmias in athletes. However, this hypothesis has not yet been confirmed in humans. Aim of this study was, therefore, to assess LA remodeling and stiffness in competitive athletes. 150 competitive athletes and 90 age and sex-matched sedentary subjects were analyzed by speckle-tracking echocardiography to measure peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS). LA stiffness was determined using E/e’ ratio in conjunction with PALS. Left ventricular (LV) stiffness was also calculated. LA volume index was greater in athletes as compared with controls (24.6 ± 7.3 vs. 18.4 ± 7.8 mL/m2, p < .0001). LA PALS, LA PACS, and E/e’ ratio were lower in athletes in comparison with controls (p < .05, p ≤ .001, and p < .0001, respectively). Despite greater LA size, competitive athletes had lower LA stiffness as compared with controls (0.13 ± 0.04 vs. 0.16 ± 0.06, p ≤ .001). In addition, LV stiffness was lower in athletes (0.84 ± 0.27 vs. 1.07 ± 0.46, p ≤ .001). The only independent predictor of LA stiffness was LV stiffness (β = 0.46, p < .0001), while the only independent predictor of LA volume index was LV end-systolic volume index (β = 0.25, p = .002). Competitive athletes showed greater LA size associated with lower stiffness as compared with controls. Thus, LA remodeling in the context of the athlete’s heart is not associated with increased LA stiffness. These findings support the benign nature of LA remodeling in athletes, occurring as a physiological adaptation to exercise conditioning.

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Acknowledgments

The work has been awarded at EuroPrevent 2014 in Amsterdam as Best Poster in the field of Sports Cardiology. The authors wish to thank managers, athletes, medical and technical staff of the Teams involved in this project. A special thank to Italian Volleyball Federation and to Marco Mencarelli and Marco Paglialunga for their support.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, University of Siena, Viale M. Bracci, 16 53100, Siena, Italy

    Flavio D’Ascenzi, Benedetta Maria Natali, Matteo Cameli, Valentina Andrei, Eufemia Incampo, Federico Alvino, Matteo Lisi, Margherita Padeletti, Marta Focardi & Sergio Mondillo

  2. Institute of Sports Medicine and Science, Rome, Italy

    Antonio Pelliccia

  3. Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy

    Marco Bonifazi

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  1. Flavio D’Ascenzi
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  2. Antonio Pelliccia
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  3. Benedetta Maria Natali
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Correspondence to Flavio D’Ascenzi.

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D’Ascenzi, F., Pelliccia, A., Natali, B.M. et al. Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete’s heart. Int J Cardiovasc Imaging 31, 699–705 (2015). https://doi.org/10.1007/s10554-015-0600-7

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  • DOI: https://doi.org/10.1007/s10554-015-0600-7

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