Atrial functional and geometrical remodeling in highly trained male athletes: for better or worse?
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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.
KeywordsAtrial strain Atrial function Echocardiography Wall stress Exercise
Cardiac magnetic resonance
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
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
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.
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