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Training-induced dynamic changes in left atrial reservoir, conduit, and active volumes in professional soccer players

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Abstract

Purpose

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.

Methods

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.

Results

Athletes had larger maximum (27.5 ± 3.2 vs. 20.3 ± 5.8 mL/m2, p = 0.001), pre-P (11.5 ± 0.9 vs. 9.8 ± 2.2 mL/m2, p = 0.001), and minimum (6.6 ± 0.9 vs. 5.0 ± 1.2 mL/m2, 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 ± 3.1 vs. 15.3 ± 4.9 mL/m2, p < 0.05 and 13.8 ± 2.9 vs. 10.5 ± 4.6 mL/m2, 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 (β = 0.74, p < 0.005).

Conclusions

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.

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Abbreviations

LA:

Left atrial

LV:

Left ventricular

BSA:

Body surface area

SV:

Stroke volume

LVM:

Left ventricular mass

EDV:

End-diastolic volume

References

  • Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, Tsang TS (2006) Left atrial size: physiological determinants and clinical implications. J Am Coll Cardiol 47:2357–2363

    Article  PubMed  Google Scholar 

  • Boyd AC, Ng AC, da Tran T, Chia EM, French JK, Leung DY, Thomas L (2010) Left atrial enlargement and phasic function in patients following non-ST elevation myocardial infarction. J Am Soc Echocardiogr 23:1251–1258

    Article  PubMed  Google Scholar 

  • Braunwald E, Frahm C (1961) Studies on Starling’s law of the heart, IV: observations on the hemodynamic functions of the left atrium in man. Circulation 24:633–642

    Article  Google Scholar 

  • Calvo N, Brugada J, Sitges M, Mont L (2012) Atrial fibrillation and atrial flutter in athletes. Br J Sports Med 46(Suppl 1):i37–i43

    Article  PubMed  Google Scholar 

  • D’Andrea A, Riegler L, Cocchia R, Scarafile R, Salerno G, Gravino R, Golia E, Vriz O, Citro R, Limongelli G, Calabrò P, Di Salvo G, Caso P, Russo MG, Bossone E, Calabrò R (2010) Left atrial volume index in highly trained athletes. Am Heart J 159:1155–1161

    Article  PubMed  Google Scholar 

  • D’Ascenzi F, Cameli M, Zacà V, Lisi M, Santoro A, Causarano A, Mondillo S (2011) Supernormal diastolic function and role of left atrial myocardial deformation analysis by 2D speckle tracking echocardiography in elite soccer players. Echocardiography 28:320–326

    Article  PubMed  Google Scholar 

  • D’Ascenzi F, Cameli M, Lisi M, Zacà V, Natali B, Malandrino A, Benincasa S, Catanese S, Causarano A, Mondillo S (2012) Left atrial remodelling in competitive adolescent soccer players. Int J Sports Med 33:795–801

    Article  PubMed  Google Scholar 

  • D’Ascenzi F, Pelliccia A, Natali BM, Cameli M, Andrei V, Incampo E, Alvino F, Lisi M, Padeletti M, Focardi M, Bonifazi M, Mondillo S (2015) Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete’s heart. Int J Cardiovasc Imaging (Epub ahead of print)

  • D’Ascenzi F, Cameli M, Padeletti M, Lisi M, Zacà V, Natali B, Malandrino A, Alvino F, Morelli M, Vassallo GM, Meniconi C, Bonifazi M, Causarano A, Mondillo S (2013) Characterization of right atrial function and dimension in top-level athletes: a speckle tracking study. Int J Cardiovasc Imaging 29:87–94

    Article  PubMed  Google Scholar 

  • Du Bois D, Du Bois EF (1916) A formula to estimate the approximate body surface area if height and weight be known. Arch Intern Med 17:863–871

    Article  Google Scholar 

  • Erol MK, Yilmaz M, Acikel M, Karakelleoglu S (2002) Left atrial mechanical function in patients with essential hypertension. Acta Cardiol 57:323–327

    Article  PubMed  Google Scholar 

  • Eshoo S, Ross DL, Thomas L (2009) Impact of mild hypertension on left atrial size and function. Circ Cardiovasc Imaging 2:93–99

    Article  PubMed  Google Scholar 

  • Eshoo S, Semsarian C, Ross DL, Thomas L (2010) Left atrial phasic volumes are modulated by the type rather than the extent of left ventricular hypertrophy. J Am Soc Echocardiogr 23:538–544

    Article  PubMed  Google Scholar 

  • Fagard R (2003) Athlete’s heart. Heart 89:1455–1461

    Article  PubMed Central  PubMed  Google Scholar 

  • Inama G, Pedrinazzi C, Durin O, Inama L, Furlanello F (2010) Atrial fibrillation and flutter in athletes. G Ital Cardiol (Rome) 11:102S–106S

    Google Scholar 

  • Jarvinen V, Kupari M, Hekali P, Poutanen VP (1994) Assessment of left atrial volumes and phasic function using cine magnetic resonance imaging in normal subjects. Am J Cardiol 73:1135–1138

    Article  CAS  PubMed  Google Scholar 

  • Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, Hoffmann W, Poller W, Schultheiss HP, Pauschinger M, Tschöpe C (2007) Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 116:637–647

    Article  PubMed  Google Scholar 

  • Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108

    Article  PubMed  Google Scholar 

  • Leung DY, Boyd A, Ng AA, Chi C, Thomas L (2008) Echocaridographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 158:836–844

    Google Scholar 

  • Mascia G, Perrotta L, Galanti G, Padeletti L (2013) Atrial fibrillation in athletes. Int J Sports Med 34:379–384

    CAS  PubMed  Google Scholar 

  • Mujika I, Padilla S (2000) Detraining: loss of training-induced physiological and performance adaptations. Part I: short term insufficient training stimulus. Sports Med 30:79–87

    Article  CAS  PubMed  Google Scholar 

  • Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A (2009) Recommendations of evalutation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193

    Article  PubMed  Google Scholar 

  • Nikitin NP, Witte KKA, Thackray SDR, Goodge LJ, Clark AL, Cleland JGF (2003) Effect of age and sex on left atrial morphology and function. Eur J Echocardiogr 4:36–42

    Article  CAS  PubMed  Google Scholar 

  • Ofman P, Khawaja O, Rahilly-Tierney CR, Peralta A, Hoffmeister P, Reynolds MR, Gaziano JM, Djousse L (2013) Regular physical activity and risk of atrial fibrillation: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol 6:252–256

    Article  PubMed  Google Scholar 

  • Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfiled MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794

    Article  CAS  PubMed  Google Scholar 

  • Pelliccia A, Maron BJ, Di Paolo FM, Biffi A, Quattrini FM, Pisicchio C, Roselli A, Caselli S, Culasso F (2005) Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol 46:690–696

    Article  PubMed  Google Scholar 

  • Pelouch V, Milerová M, Ostádal B, Hucín B, Samánek M (1995) Differences between atrial and ventricular protein profiling in children with congenital heart disease. Mol Cell Biochem 147:43–49

    Article  CAS  PubMed  Google Scholar 

  • Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE (2000) The athlete’s heart: a meta-analysis of cardiac structure and function. Circulation 101:336–344

    Article  CAS  PubMed  Google Scholar 

  • Prioli A, Marino P, Lanzoni L, Zardini P (1998) Increasing degrees of left ventricular filling impairment modulate left atrial function in humans. Am J Cardiol 82:756–761

    Article  CAS  PubMed  Google Scholar 

  • Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines of the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713

    Article  PubMed  Google Scholar 

  • Spencer KT, Mor-Avi V, Gorcsan J 3rd, DeMaria AN, Kimball TR, Monaghan MJ, Perez JE, Weinert L, Bednarz J, Edelman K, Kwan OL, Glascock B, Hancock J, Baumann C, Lang RM (2001) Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart 85:272–277

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL (2002) Compensatory changes in atrial volumes with normal aging: is atrial enlargement inevitable? J Am Coll Cardiol 40:1630–1635

    Article  PubMed  Google Scholar 

  • Tükek T, Akkaya V, Atilgan D, Demirel E, Ozcan M, Güven O, Korkut F (2001) Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation. Clin Cardiol 24:676–680

    Article  PubMed  Google Scholar 

  • Utomi V, Oxborough D, Whyte GP, Somauroo J, Sharma S, Shave R, Atkinson G, George K (2013) Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete’s heart. Heart 99:1727–1733

    Article  PubMed  Google Scholar 

  • Yu CM, Sanderson JE, Marwick OhJK (2007) Tissue Doppler imaging a new prognosticator for cardiovascular disease. J Am Coll Cardiol 49:1903–1914

    Article  PubMed  Google Scholar 

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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, Matteo Lisi, Marta Focardi, Margherita Padeletti & Sergio Mondillo

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

    Antonio Pelliccia

  3. Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy

    Paola Palmitesta

  4. Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy

    Domenico Corrado

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

    Marco Bonifazi

  6. Department of Public Health and Clinical Medicine, Umeå University, and Heart Centre, Umeå, Sweden

    Michael Henein

Authors
  1. Flavio D’Ascenzi
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  2. Antonio Pelliccia
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  3. Benedetta Maria Natali
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  4. Matteo Cameli
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  5. Matteo Lisi
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  6. Marta Focardi
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  7. Margherita Padeletti
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  8. Paola Palmitesta
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  9. Domenico Corrado
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  10. Marco Bonifazi
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  11. Sergio Mondillo
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  12. Michael Henein
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Corresponding author

Correspondence to Flavio D’Ascenzi.

Additional information

Communicated by Keith Phillip George.

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D’Ascenzi, F., Pelliccia, A., Natali, B.M. et al. Training-induced dynamic changes in left atrial reservoir, conduit, and active volumes in professional soccer players. Eur J Appl Physiol 115, 1715–1723 (2015). https://doi.org/10.1007/s00421-015-3151-7

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  • DOI: https://doi.org/10.1007/s00421-015-3151-7

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