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Atrial size and sports. A great training for a greater left atrium: how much is too much?

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Abstract

Athlete’s heart results from physiological adaptations to the increased demands of exercise, and left atrial (LA) enlargement (LAE) is a fundamental component. However, LAE occurs in certain pathological conditions and it might represent a diagnostic challenge in athletes. LA volume index (LAVi) by echo is a convenient diagnostic tool for LAE identification. We hypothesized that accumulated lifetime training thousand hours (LTH) would have a main role in LAE. Therefore, our aim was to assess the association between LTH, LAVi and LAE in athletes. Young and middle-aged males with different training levels were included and grouped as recreational (REa, n = 30), competitive (COa, n = 169) and elite (ELa, n = 80) athletes for LTH calculation and echo assessment. LA dimensions resulted greater in ELa when compared to other groups (p < 0.001). LAVi correlated stronger with LTH than with age (p < 0.001). Polynomial regression analysis showed a non-linear, almost triphasic, effect of cumulative training on LA size (p < 0.02). Multivariate logistic regression, including LTH, age, body surface area, systolic blood pressure and other explanatory variables to predict LAE, showed LTH as the sole significant factor [OR 1.45 (CI 1.1–1.92), p < 0.008]. ROC analysis found an optimal cut off point of 3.6 LTH for LAE identification (AUC = 0.84, p < 0.001. RR = 5.65, p < 0.001). We conclude that LAE associates with LTH more than with other clinical parameters, and with less impact at higher amounts of LTH. Lifetime training greater than 3600 hours increases the probability of finding LAE in athletes. Future research should provide more insights and implications of these findings.

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Acknowledgements

Authors would like to thank Technician Sabrina Pardini and Mariana Soffer for their assistance.

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Author notes

  1. Gonzalo Diaz Babio and Gustavo Vera Janavel have contributed equally to this work.

Authors and Affiliations

  1. Department of Sports Medicine, ICSI, Las Lomas Clinic, Buenos Aires, Argentina

    Gonzalo Diaz Babio, Gustavo Vera Janavel & Teresa Garcia Botta

  2. Department of Cardiovascular Imaging, ICSI, Las Lomas Clinic, Buenos Aires, Argentina

    Ivan Constantin, Gerardo Masson, Celeste Carrero, Maria Mezzadra & Pablo Stutzbach

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  1. Gonzalo Diaz Babio
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  2. Gustavo Vera Janavel
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  3. Ivan Constantin
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Correspondence to Gonzalo Diaz Babio or Gustavo Vera Janavel.

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Diaz Babio, G., Vera Janavel, G., Constantin, I. et al. Atrial size and sports. A great training for a greater left atrium: how much is too much?. Int J Cardiovasc Imaging 37, 981–988 (2021). https://doi.org/10.1007/s10554-020-02082-2

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  • DOI: https://doi.org/10.1007/s10554-020-02082-2

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