Abstract
Biatrial enlargement is common in athletes with a further increase occurring after training. P-wave morphology seems to be unaffected by atrial size, however longitudinal data are not available. This study aimed to prospectively investigate whether exercise-induced increase in biatrial size corresponds to electrical changes on 12-lead ECG. Thirty-five athletes were evaluated at the beginning of the training and after 6 months by ECG and standard and speckle-tracking echocardiography. Twenty-three sedentary subjects served as controls. Athletes had greater left atrial (LA) and right atrial (RA) size compared with controls (20.7 ± 4.7 vs. 27.1 ± 6.6 and 17.3 ± 3.8 vs. 23.4 ± 6.3 mL/m2, respectively, p < 0.0001). After 6 months, a further increase in LA and RA size was observed (p < 0.0001 and p = 0.002, respectively). Neither athletes nor controls fulfilled the ECG criteria for RA enlargement and no differences were found for LA enlargement criteria between athletes and controls (2/35, 6 % vs. 0/23, 0 %, p = 0.23). This percentage remained unchanged after training. Biatrial stiffness remained normal in athletes also after training. Training causes an increase in biatrial volumes, with normal filling pressures and normal stiffness. These changes in atrial morphology are not associated with respective electrical changes, suggesting that P-wave morphology is unaffected by training-induced biatrial dilatation in young healthy athletes.
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Drezner JA, Ashley E, Baggish AL, Borjesson M, Corrado D, Owens DS, Patel A, Pelliccia A, Vetter VL, Ackerman MJ, Anderson J, Asplund CA, Cannon BC, DiFiori J, Fischbach P, Froelicher V, Harmon KG, Heidbuchel H, Marek J, Paul S, Prutkin JM, Salerno JC, Schmied CM, Sharma S, Stein R, Wilson M (2013) Abnormal electrocardiographic findings in athletes: recognising changes suggestive of cardiomyopathy. Br J Sports Med 47:137–152
Baggish AL, Wang F, Weiner RB, Elinoff JM, Tournoux F, Boland A, Picard MH, Hutter AM Jr, Wood MJ (1985) Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes (2008). J Appl Physiol 104:1121–1128
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
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
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
Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjornstad HH, Carrè F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedk N, Solberg E, Vanhees L, Drezner J, Estes NAM, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, Zeppilli P, McKenna WJ (2010) Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 31:243–259
Drezner JA, Fischbach P, Froelicher V, Marek J, Pelliccia A, Prutkin JM, Schmied CM, Sharma S, Wilson MG, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, Borjesson M, Cannon BC, Corrado D, DiFiori JP, Harmon KG, Heidbuchel H, Owens DS, Paul S, Salerno JC, Stein R, Vetter VL (2013) Normal electrocardiographic findings: recognising physiological adaptations in athletes. Br J Sports Med 47:125–136
Gati S, Sheikh N, Ghani S, Zaidi A, Wilson M, Raju H, Cox A, Reed M, Papadakis M, Sharma S (2013) Should axis deviation or atrial enlargement be categorised as abnormal in young athletes? The athlete’s electrocardiogram: time for re-appraisal of markers of pathology. Eur Heart J 34:3641–3648
Petersson R, Berge HM, Gjerdalen GF, Carlson J, Holmqvist F, Steine K, Platonov PG (2014) P-wave morphology is unaffected by atrial size: a study in healthy athletes. Ann Noninvasive Electrocardiol 19:366–373
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 16:233–270
Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, Morehead A, Kitzman D, Oh J, Quinones M, Schiller NB, Stein JH, Weissman NJ (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 17:1086–1119
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Shiller NB (2010) Guidelines for 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 Echocardiography. J Am Soc Echocardiogr 23:685–713
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
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
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 12:167–205
Padeletti M, Cameli M, Lisi M, Malandrino A, Zacà V, Mondillo S (2012) Reference values of right atrial longitudinal strain imaging by two-dimensional speckle tracking. Echocardiography 29:147–152
Kurt M, Wang J, Torre-Amione G, Nagueh SF (2009) Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2:10–15
Appleton CP, Kovács SJ (2009) The role of left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2:6–9
Bazett HC (1920) An analysis of the time-relations of electrocardiograms. Heart 7:353–370
Sokolow M, Lyon TP (1949) The ventricular complex in left ventricular hypertrophy obtained by unipolar precordial and limb leads. Am Heart J 37:161–186
Sokolow M, Lyon TP (1949) The ventricular complex in right ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 38:273
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
D’Ascenzi F, Pelliccia A, Natali BM, Zacà 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. Cir Cardiovasc Imaging 7:222–229
D’Ascenzi F, Pelliccia A, Natali BM, Cameli M, Lisi M, Focardi M, Padeletti M, Palmitesta P, Corrado D, Bonifazi M, Mondillo S, Henein M (2015) Training-induced dynamic changes in left atrial reservoir, conduit and active volumes in professional soccer players. Eur J Appl Physiol 115:1715–1723
Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, Caselli G, Piovano P (2000) Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 102:278–284
Machino-Ohtsuka T, Seo Y, Tada H, Ishizu T, Machino T, Yamasaki H, Igarashi M, Xu D, Sekiguchi Y, Aonuma K (2011) Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation. J Cardiovasc Electrophysiol 22:999–1006
Shaikh AY, Maan A, Khan UA, Aurigemma GP, Hill JC, Kane JL, Tighe DA, Mick E, McManus DD (2012) Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study. J Cardiovasc ultrasound 10:48
Yoon YEY, Kim HJ, Kim SA, Kim SH, Park JH, Park KH, Choi S, Kim MK, Kim HS, Cho GY (2012) Left atrial mechanical function and stiffness in patients with paroxysmal atrial fibrillation. J Cardiovasc Ultrasound 20:140–145
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
D’Andrea A, De Corato G, Scarafile R, Romano S, Reigler L, Mita C, Allocca F, Limongelli G, Gigantino G, Liccardo B, Cuomo S, Tagliamonte G, Caso P, Calabrò R (2008) Left atrial myocardial function in either physiological or pathological left ventricular hypertrophy: a two-dimensional speckle strain study. Br J Sports Med 42:696–702
Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G (2006) Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 296:1593–1601
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D’Ascenzi, F., Solari, M., Biagi, M. et al. P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletes. Int J Cardiovasc Imaging 32, 407–415 (2016). https://doi.org/10.1007/s10554-015-0790-z
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DOI: https://doi.org/10.1007/s10554-015-0790-z