Skip to main content
SpringerLink
Log in

Left atrial functional response after a marathon in healthy amateur volunteers

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Middle-aged marathon runners have an increased risk of developing atrial fibrillation (AF). A previous study described that repetitive marathon running was associated with left atrial (LA) dysfunction. However, whether this change is common in marathon runners and which runners are at risk of LA dysfunction remain unknown. The purpose of this study was to determine which factors could predict LA dysfunction. We prospectively examined 12 healthy amateur volunteers (9 males, 31 ± 8 years old) who participated in a full marathon. All echocardiographic measurements and speckle-tracking echocardiography were performed before and after the marathon. The endpoint was defined as reduced LA reservoir strain 1 day after the marathon (non-responder group). Seven participants were in the non-responder group. Age (35 ± 9 vs. 26 ± 2 years, p = 0.020), augmentation index (76 ± 12 vs. 55 ± 8, p = 0.002), and diastolic blood pressures (83 ± 11 vs. 70 ± 7 mmHg, p = 0.021) in the non-responder group were significantly higher compared with the responder group. In multivariate linear regression analysis, only the augmentation index was an independent predictor of reduced LA reservoir function after the marathon (β = − 0.646, p = 0.023). The augmentation index was a predictive marker for reduction in LA reservoir function after a marathon in healthy amateur volunteers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M (1998) Lone atrial fibrillation in vigorously exercising middle aged men: case–control study. BMJ 316(7147):1784–1785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, Jenni R, Oechslin E, Luthi P, Scharf C, Marti B, Attenhofer Jost CH (2008) Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J 29(1):71–78. https://doi.org/10.1093/eurheartj/ehm555

    Article  PubMed  Google Scholar 

  3. Mont L, Tamborero D, Elosua R, Molina I, Coll-Vinent B, Sitges M, Vidal B, Scalise A, Tejeira A, Berruezo A, Brugada J, Investigators G (2008) Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace 10(1):15–20. https://doi.org/10.1093/europace/eum263

    Article  PubMed  Google Scholar 

  4. Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM (2009) Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol 103(11):1572–1577. https://doi.org/10.1016/j.amjcard.2009.01.374

    Article  PubMed  PubMed Central  Google Scholar 

  5. Grimsmo J, Grundvold I, Maehlum S, Arnesen H (2010) High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors—a 28–30 years follow-up study. Eur J Cardiovasc Prev Rehabil 17(1):100–105. https://doi.org/10.1097/HJR.0b013e32833226be

    Article  PubMed  Google Scholar 

  6. Oxborough D, Whyte G, Wilson M, O’Hanlon R, Birch K, Shave R, Smith G, Godfrey R, Prasad S, George K (2010) A depression in left ventricular diastolic filling following prolonged strenuous exercise is associated with changes in left atrial mechanics. J Am Soc Echocardiogr 23(9):968–976. https://doi.org/10.1016/j.echo.2010.06.002

    Article  PubMed  Google Scholar 

  7. Inaba Y, Yuda S, Kobayashi N, Hashimoto A, Uno K, Nakata T, Tsuchihashi K, Miura T, Ura N, Shimamoto K (2005) Strain rate imaging for noninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibrillation. J Am Soc Echocardiogr 18(7):729–736. https://doi.org/10.1016/j.echo.2004.12.005

    Article  PubMed  Google Scholar 

  8. Muranaka A, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T, Tsuzuki M, Wakabayashi C, Watanabe N, Shimamoto K (2009) Quantitative assessment of left ventricular and left atrial functions by strain rate imaging in diabetic patients with and without hypertension. Echocardiography 26(3):262–271. https://doi.org/10.1111/j.1540-8175.2008.00805.x

    Article  PubMed  Google Scholar 

  9. Montserrat S, Gabrielli L, Bijnens B, Borras R, Berruezo A, Poyatos S, Brugada J, Mont L, Sitges M (2015) Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation. Heart Rhythm 12(1):11–18. https://doi.org/10.1016/j.hrthm.2014.08.032

    Article  PubMed  Google Scholar 

  10. Leong DP, Penhall A, Perry R, Shirazi M, Altman M, Chong D, Bradley J, Joseph MX, Selvanayagam JB (2013) Speckle-tracking strain of the left atrium: a transoesophageal echocardiographic validation study. Eur Heart J Cardiovasc Imaging 14(9):898–905. https://doi.org/10.1093/ehjci/jes323

    Article  PubMed  Google Scholar 

  11. Gabrielli L, Bijnens BH, Butakoff C, Duchateau N, Montserrat S, Merino B, Gutierrez J, Paré C, Mont L, Brugada J, Sitges M (2014) Atrial functional and geometrical remodeling in highly trained male athletes: for better or worse? Eur J Appl Physiol 114(6):1143–1152. https://doi.org/10.1007/s00421-014-2845-6

    Article  PubMed  Google Scholar 

  12. D’Ascenzi F, Pelliccia A, Natali BM, Zaca V, Cameli M, Alvino F, Malandrino A, Palmitesta P, Zorzi A, Corrado D, Bonifazi M, Mondillo S (2014) Morphological and functional adaptation of left and right atria induced by training in highly trained female athletes. Circ Cardiovasc Imaging 7(2):222–229. https://doi.org/10.1161/CIRCIMAGING.113.001345

    Article  PubMed  Google Scholar 

  13. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging 16(3):233–271. https://doi.org/10.1093/ehjci/jev014

    Article  PubMed  Google Scholar 

  14. Hayashi S, Yamada H, Bando M, Saijo Y, Nishio S, Hirata Y, Klein AL, Sata M (2015) Optimal analysis of left atrial strain by speckle tracking echocardiography: P-wave versus R-wave trigger. Echocardiography 32(8):1241–1249. https://doi.org/10.1111/echo.12834

    Article  PubMed  Google Scholar 

  15. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12(3):167–205. https://doi.org/10.1093/ejechocard/jer021

    Article  PubMed  Google Scholar 

  16. Heidbuchel H, Anne W, Willems R, Adriaenssens B, Van de Werf F, Ector H (2006) Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol 107(1):67–72. https://doi.org/10.1016/j.ijcard.2005.02.043

    Article  PubMed  Google Scholar 

  17. Abdulla J, Nielsen JR (2009) Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace 11(9):1156–1159. https://doi.org/10.1093/europace/eup197

    Article  PubMed  Google Scholar 

  18. Calvo N, Mont L, Tamborero D, Berruezo A, Viola G, Guasch E, Nadal M, Andreu D, Vidal B, Sitges M, Brugada J (2010) Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes. Europace 12(1):30–36. https://doi.org/10.1093/europace/eup320

    Article  PubMed  Google Scholar 

  19. D’Ascenzi F, Cameli M, Zaca 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(3):320–326. https://doi.org/10.1111/j.1540-8175.2010.01338.x

    Article  PubMed  Google Scholar 

  20. Pelliccia A, Maron BJ, De Luca R, Di Paolo FM, Spataro A, Culasso F (2002) Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation 105(8):944–949

    Article  PubMed  Google Scholar 

  21. Benito B, Gay-Jordi G, Serrano-Mollar A, Guasch E, Shi Y, Tardif JC, Brugada J, Nattel S, Mont L (2011) Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation 123(1):13–22. https://doi.org/10.1161/CIRCULATIONAHA.110.938282

    Article  PubMed  Google Scholar 

  22. Guasch E, Benito B, Qi X, Cifelli C, Naud P, Shi Y, Mighiu A, Tardif JC, Tadevosyan A, Chen Y, Gillis MA, Iwasaki YK, Dobrev D, Mont L, Heximer S, Nattel S (2013) Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol 62(1):68–77. https://doi.org/10.1016/j.jacc.2013.01.091

    Article  PubMed  Google Scholar 

  23. Maron BJ, Pelliccia A, Spirito P (1995) Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 91(5):1596–1601

    Article  CAS  PubMed  Google Scholar 

  24. 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(3):336–344

    Article  CAS  PubMed  Google Scholar 

  25. Maron BJ, Pelliccia A (2006) The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 114(15):1633–1644. https://doi.org/10.1161/CIRCULATIONAHA.106.613562

    Article  PubMed  Google Scholar 

  26. Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, Rebato C, Elosua R (2008) Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace 10(5):618–623. https://doi.org/10.1093/europace/eun071

    Article  PubMed  Google Scholar 

  27. Wilhelm M, Roten L, Tanner H, Wilhelm I, Schmid JP, Saner H (2011) Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol 108(4):580–585. https://doi.org/10.1016/j.amjcard.2011.03.086

    Article  PubMed  Google Scholar 

  28. Wilhelm M, Nuoffer JM, Schmid JP, Wilhelm I, Saner H (2012) Comparison of pro-atrial natriuretic peptide and atrial remodeling in marathon versus non-marathon runners. Am J Cardiol 109(7):1060–1065. https://doi.org/10.1016/j.amjcard.2011.11.039

    Article  CAS  PubMed  Google Scholar 

  29. Brugger N, Krause R, Carlen F, Rimensberger C, Hille R, Steck H, Wilhelm M, Seiler C (2014) Effect of lifetime endurance training on left atrial mechanical function and on the risk of atrial fibrillation. Int J Cardiol 170(3):419–425. https://doi.org/10.1016/j.ijcard.2013.11.032

    Article  PubMed  Google Scholar 

  30. Sanz-de la Garza M, Grazioli G, Bijnens BH, Sarvari SI, Guasch E, Pajuelo C, Brotons D, Subirats E, Brugada R, Roca E, Sitges M (2016) Acute, exercise dose-dependent impairment in atrial performance during an endurance race: 2D ultrasound speckle-tracking strain analysis. JACC 9(12):1380–1388. https://doi.org/10.1016/j.jcmg.2016.03.016

    Article  PubMed  Google Scholar 

  31. Cioffi G, de Simone G, Mureddu G, Tarantini L, Stefenelli C (2007) Right atrial size and function in patients with pulmonary hypertension associated with disorders of respiratory system or hypoxemia. Eur J Echocardiogr 8(5):322–331. https://doi.org/10.1016/j.euje.2006.06.006

    Article  PubMed  Google Scholar 

  32. von Roeder M, Rommel KP, Kowallick JT, Blazek S, Besler C, Fengler K, Lotz J, Hasenfuss G, Lucke C, Gutberlet M, Schuler G, Schuster A, Lurz P (2017) Influence of left atrial function on exercise capacity and left ventricular function in patients with heart failure and preserved ejection fraction. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.116.005467

    Article  Google Scholar 

  33. Habibi M, Samiei S, Ambale Venkatesh B, Opdahl A, Helle-Valle TM, Zareian M, Almeida AL, Choi EY, Wu C, Alonso A, Heckbert SR, Bluemke DA, Lima JA (2016) Cardiac magnetic resonance-measured left atrial volume and function and incident atrial fibrillation: results from MESA (multi-ethnic study of atherosclerosis). Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.115.004299

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pessoa-Amorim G, Mancio J, Vouga L, Ribeiro J, Gama V, Bettencourt N, Fontes-Carvalho R (2018) Impaired left atrial strain as a predictor of new-onset atrial fibrillation after aortic valve replacement independently of left atrial size. Rev Esp Cardiol 71(6):466–476. https://doi.org/10.1016/j.rec.2017.10.005

    Article  PubMed  Google Scholar 

  35. Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P (2004) The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension 44(4):398–404. https://doi.org/10.1161/01.HYP.0000142248.54761.56

    Article  CAS  PubMed  Google Scholar 

  36. Doi M, Miyoshi T, Hirohata S, Iwabu A, Tominaga Y, Kaji Y, Kamikawa S, Sakane K, Kitawaki T, Kusano KF, Kusachi S (2009) Increased augmentation index of the radial pressure waveform in patients with paroxysmal atrial fibrillation. Cardiology 113(2):138–145. https://doi.org/10.1159/000177951

    Article  PubMed  Google Scholar 

  37. Mohlenkamp S, Lehmann N, Breuckmann F, Brocker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jockel KH, Erbel R, Marathon Study I, Heinz Nixdorf Recall Study I (2008) Running: the risk of coronary events: Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J 29(15):1903–1910. https://doi.org/10.1093/eurheartj/ehn163

    Article  PubMed  Google Scholar 

  38. Breuckmann F, Mohlenkamp S, Nassenstein K, Lehmann N, Ladd S, Schmermund A, Sievers B, Schlosser T, Jockel KH, Heusch G, Erbel R, Barkhausen J (2009) Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners. Radiology 251(1):50–57. https://doi.org/10.1148/radiol.2511081118

    Article  PubMed  Google Scholar 

  39. Karlstedt E, Chelvanathan A, Da Silva M, Cleverley K, Kumar K, Bhullar N, Lytwyn M, Bohonis S, Oomah S, Nepomuceno R, Du X, Melnyk S, Zeglinski M, Ducas R, Sefidgar M, Mackenzie S, Sharma S, Kirkpatrick ID, Jassal DS (2012) The impact of repeated marathon running on cardiovascular function in the aging population. J Cardiovasc Magn Reson 14:58. https://doi.org/10.1186/1532-429X-14-58

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors acknowledge Kathryn Brock, BA, for her work editing the manuscript. The authors gratefully acknowledge the volunteers and staff in the Ultrasound Examination Center, Tokushima University Hospital.

Funding

This work was partially supported by JSPS Kakenhi Grants (Number 17K13037 to Y.Hirata, Number 15K19381/17K09506 to K. Kusunose, and Nos. 16H05299/26248050 to M. Sata) and a grant-in-aid from the Takeda Science Foundation (to M.S.), the Fugaku Trust for Medical Research (to M.S.), the Vehicle Racing Commemorative Foundation (to M.S.) and Uehara Memorial Foundation (to K.K.).

Author information

Authors and Affiliations

  1. Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan

    Yukina Hirata, Kenya Kusunose, Hirotsugu Yamada, Sae Morita, Yuta Torii, Susumu Nishio & Masataka Sata

  2. Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, Japan

    Kenya Kusunose, Robert Zheng, Yoshihito Saijo, Daiju Fukuda, Shusuke Yagi, Takeshi Soeki & Masataka Sata

  3. Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Hirotsugu Yamada

Authors
  1. Yukina Hirata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenya Kusunose
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirotsugu Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sae Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuta Torii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susumu Nishio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshihito Saijo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daiju Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shusuke Yagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takeshi Soeki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Masataka Sata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenya Kusunose.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirata, Y., Kusunose, K., Yamada, H. et al. Left atrial functional response after a marathon in healthy amateur volunteers. Int J Cardiovasc Imaging 35, 633–643 (2019). https://doi.org/10.1007/s10554-018-1502-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1502-2

Keywords

Search

Navigation