European Journal of Applied Physiology

, Volume 114, Issue 6, pp 1143–1152 | Cite as

Atrial functional and geometrical remodeling in highly trained male athletes: for better or worse?

  • Luigi Gabrielli
  • Bart H. Bijnens
  • Constantine Butakoff
  • Nicolas Duchateau
  • Silvia Montserrat
  • Beatriz Merino
  • Josep Gutierrez
  • Carles Paré
  • Lluis Mont
  • Josep Brugada
  • Marta Sitges
Original Article



Highly trained athletes have an increased risk of atrial arrhythmias. Atrial geometrical and functional remodeling may be the underlying substrate. We analyze and relate atrial size, deformation and performance in professional handball players compared with non-sportive subjects.


24 Professional handball players and 20 non-sportive males were compared. All subjects underwent an echocardiographic study with evaluation of left (LA), right atrial (RA) dimensions and deformation by strain (Sa) and strain rate (SRa). Atrial performance was assessed from the atrial stroke volume (SV). With computational geometrical models, we studied the relation between atrial volumes, strains and SV and compared atrial working conditions. We estimated the functional reserve and a resulting average wall stress.


LA and RA volumes were larger in athletes than in controls (35.2 ± 8.8 vs. 24.8 ± 4.3 ml/m2, p < 0.01 and 29.0 ± 8.4 vs. 19.0 ± 5.1 ml/m2, p < 0.01 respectively). LASa and RASa during active atrial contraction were decreased in athletes (−12.2 ± 2.0 vs. −14.5 ± 2.1 %, p < 0.01 and −12.1 ± 1.8 vs. −14.2 ± 1.5 %, p < 0.01 respectively). LASV was similar between groups (6.6 ± 1.4 vs. 7.3 ± 1.1 ml, p = 0.19) and RASV was lower in athletes (6.2 ± 1.3 vs. 7.2 ± 1.1 ml, p < 0.01). Computational models showed that this different operational mode potentially increases performance reserve, but at the cost of higher atrial wall stress.


A proportion of athletes with enlarged LA and RA showed different atrial contractile performance, likely resulting in atria working at higher wall stress.


Atrial strain Atrial function Echocardiography Wall stress Exercise 



Atrial fibrillation


Cardiac magnetic resonance


Left atrium


Peak negative left atrial strain during active atrial contraction


Peak negative left atrial strain rate during active atrial contraction


LA early diastolic peak strain rate


LA peak strain rate during ventricular systole


LA peak strain during ventricular systole


Left ventricle


Right atrium


Peak negative right atrial strain during active atrial contraction


Peak negative right atrial strain rate during active atrial contraction


RA early diastolic peak strain rate


RA peak strain rate during ventricular systole


RA peak strain during ventricular systole


Right ventricle


Stroke volume



This study was partially supported by Grants from the “Generalitat de Catalunya (Consell Catala de l’Esport)”, from “Grupo Memora (SFB-Grupo Memora)”, Spanish Society of Cardiology (Spanish Heart Foundation), from the “Plan Nacional I + D + I”, Spanish Government (DEP2010-20565), and from the “Subprograma de Proyectos en Salud”, Instituto de Salud Carlos III, Spanish Government (FIS—PI11/01709).

Conflict of interest

Authors have nothing to disclose.

Supplementary material

421_2014_2845_MOESM1_ESM.doc (294 kb)
Supplementary material 1 (DOC 294 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Luigi Gabrielli
    • 1
    • 2
  • Bart H. Bijnens
    • 3
    • 4
  • Constantine Butakoff
    • 3
  • Nicolas Duchateau
    • 1
  • Silvia Montserrat
    • 1
  • Beatriz Merino
    • 1
  • Josep Gutierrez
    • 5
  • Carles Paré
    • 1
  • Lluis Mont
    • 1
  • Josep Brugada
    • 1
  • Marta Sitges
    • 1
  1. 1.Thorax Clinic Institute, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i SunyerUniversity of BarcelonaBarcelonaSpain
  2. 2.Cardiovascular Disease DivisionPontificia Universidad Católica de ChileSantiagoChile
  3. 3.Universitat Pompeu FabraBarcelonaSpain
  4. 4.ICREA (Institució Catalana de Recerca i Estudis Avançats)BarcelonaSpain
  5. 5.Consell Catala de l′EsportBarcelonaSpain

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