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Atrial function and loading conditions in athletes
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-0947-6836
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Intensive training is associated with hemodynamic changes that typically induce an enlargement of cardiac chamber. Despite LA dilatation in athletes has been interpreted as a benign adaptation, little evidence is available. The aim of this thesis is to demonstrate that LA size changes in response to alterations in loading conditions and to analyse atrial myocardial function in athletes through the application of novel echocardiographic techniques.

We found that top-level athletes exhibit a dynamic morphological and functional LA remodelling, induced by training, with an increase in reservoir and conduit volumes, but stable active volume. Training causes an increase in biatrial volumes which is accompanied by normal filling pressures and stiffness. These changes in atrial morphology are not associated with respective electrical changes. Extending the evidence from adult athletes to children, we found that training-induced atrial remodelling can occur in the early phases of the sports career and is associated with a preserved biatrial function. Finally, in a meta-analysis study of the available evidence we demonstrated that atrial function and size are not affected by aging.

In conclusions, athlete’s heart is characterized by a physiological biatrial enlargement. This adaptation occurs in close association with LV cavity enlargement, is dynamic and reversible. This increase in biatrial size is not intrinsically an expression of atrial dysfunction. Indeed, in athletes the atria are characterized by a preserved reservoir function, normal myocardial stiffness, and dynamic changes in response to different loading conditions.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2017. , 100 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1898
Keyword [en]
athlete's heart, training, exercise, speckle-tracking echocardiography, atrial strain, atrial deformation
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-134873ISBN: 978-91-7601-715-9 (print)OAI: oai:DiVA.org:umu-134873DiVA: diva2:1095487
Public defence
2017-06-12, Hörsal D, Unod T9, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2017-05-22 Created: 2017-05-15 Last updated: 2017-05-24Bibliographically approved
List of papers
1. Training-induced dynamic changes in left atrial reservoir, conduit, and active volumes in professional soccer players
Open this publication in new window or tab >>Training-induced dynamic changes in left atrial reservoir, conduit, and active volumes in professional soccer players
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2015 (English)In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 115, no 8, 1715-1723 p.Article in journal (Refereed) Published
Abstract [en]

Although left atrial (LA) enlargement is a recognized component of athlete's heart, dynamic cavity changes occurring during the training period remain to be elucidated. We aimed to investigate the adaptive changes of LA reservoir, conduit, and active volumes in elite athletes vs. controls and their response to different training loads. LA maximum, pre-P, and minimum volumes were assessed in 26 top-level athletes and 23 controls. In athletes, LA volumes were measured at pre-, mid-, end-training, and post-detraining time points using conventional 2D echocardiography. Athletes had larger maximum (27.5 +/- A 3.2 vs. 20.3 +/- A 5.8 mL/m(2), p = 0.001), pre-P (11.5 +/- A 0.9 vs. 9.8 +/- A 2.2 mL/m(2), p = 0.001), and minimum (6.6 +/- A 0.9 vs. 5.0 +/- A 1.2 mL/m(2), p < 0.001) LA indexed volumes, compared with controls. Total and passive emptying volume indices were also larger in athletes compared with controls (18.7 +/- A 3.1 vs. 15.3 +/- A 4.9 mL/m(2), p < 0.05 and 13.8 +/- A 2.9 vs. 10.5 +/- A 4.6 mL/m(2), p < 0.05, respectively), while active emptying volume was similar (p = 0.74). During training, LA maximum (p < 0.0001), pre-P (p < 0.0001), minimum (p < 0.0001), total (p < 0.005), and passive (p < 0.05) emptying volume indices progressively increased, while active emptying volume (p = 0.10) and E/e' ratio (p = 0.32) remained unchanged. After detraining, LA volume measurements were not different from pre-training ones. End-training left ventricular mass index was the only independent predictor of the respective maximum LA volume (beta = 0.74, p < 0.005). Top-level athletes exhibit a dynamic morphological and functional LA remodeling, induced by training, with an increase in reservoir and conduit volumes, but stable active volume. LA remodeling is closely associated with left ventricular adaptation to exercise and both completely regress after detraining.

Place, publisher, year, edition, pages
Springer, 2015
Keyword
Athlete's heart, Exercise, Training, Atrial function, Atrial remodeling, Phasic volumes
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine, cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-106766 (URN)10.1007/s00421-015-3151-7 (DOI)000358026000011 ()25808863 (PubMedID)
Available from: 2015-08-20 Created: 2015-08-07 Last updated: 2017-05-19Bibliographically approved
2. P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletes
Open this publication in new window or tab >>P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletes
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2016 (English)In: International Journal of Cardiac Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 32, no 3, 407-415 p.Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine, cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-112219 (URN)10.1007/s10554-015-0790-z (DOI)000370166100005 ()26474571 (PubMedID)
Available from: 2015-12-04 Created: 2015-12-04 Last updated: 2017-05-19Bibliographically approved
3. Atrial chamber remodelling in healthy pre-adolescent athletes engaged in endurance sports: A study with a longitudinal design. The CHILD study
Open this publication in new window or tab >>Atrial chamber remodelling in healthy pre-adolescent athletes engaged in endurance sports: A study with a longitudinal design. The CHILD study
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 223, 325-330 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Previous studies investigated the exercise-induced adaptation of left (LA) and right atrium (RA) in adults, but little is known about respective changes in the growing heart of children. We aimed to longitudinally investigate the effects of endurance training on biatrial remodelling in preadolescent athletes.

METHODS AND RESULTS: Ninety-four children (57 endurance athletes, 37 sedentary controls; mean age 10.8±0.2 and 10.2±0.2years, respectively) were evaluated at baseline and after 5months by ECG and by two-dimensional, three-dimensional (3D) and speckle-tracking echocardiography. Athletes were trained at least 10h/week. The resting heart rate was lower in athletes (p=0.046) and decreased further after training (p<0.0001). Neither athletes nor controls had ECG evidence for LA or RA enlargement. At baseline, indexed LA volumes did not differ between groups (p=0.14) but indexed RA dimensions were larger in athletes (p=0.007). After 5months, indexed LA volumes increased in athletes but not in controls (p<0.0001, p=0.29; respectively) while indexed RA volumes increased in both groups (p<0.0001, p=0.018; respectively). At the same time, slight differences in biatrial reservoir and contractile function were found either in athletes, as demonstrated by speckle-tracking echocardiography, but 3D-derived LA and RA ejection fraction remained stable in both groups.

CONCLUSION: Endurance training influences the growing heart of preadolescent athletes with an additive increase in biatrial size, suggesting that morphological adaptations can occur also in the early phases of the sports career. Training-induced remodelling was associated with a preserved biatrial function, supporting the hypothesis of a physiological remodelling.

Keyword
Speckle-tracking echocardiography, Atrial strain, Training, 3-dimensional echocardiography, Echocardiography, athlete's heart
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-127537 (URN)10.1016/j.ijcard.2016.08.231 (DOI)000387036200102 ()27543703 (PubMedID)
Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2017-05-19Bibliographically approved
4. The impact of aging on left atrial size and function: a systematic review and meta-analysis in healthy subjects
Open this publication in new window or tab >>The impact of aging on left atrial size and function: a systematic review and meta-analysis in healthy subjects
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background. The cardiovascular system is affected by aging, however conflicting results cloud this relationship and data on LA myocardial function and aging are scanty. The aim of this study was to evaluate the impact of aging on LA size and function in healthy subjects.

Methods. We conducted a systematic literature search of MEDLINE database. We included only studies evaluating healthy subjects, with age ranged between 18 and 80 years. Parameters were compared among 4 age groups, <30, 30-45, >45-60, >60 years.

Results. Three hundred twenty-six studies met the inclusion criteria and the final population consisted of 62,821 subjects. LA antero-posterior diameter and LA volume gradually increased with aging, however LA volume index did not differ among groups. LA ejection fraction measured by three-dimensional echocardiography modestly reduced with age (p=0.049), but respective measurements derived by two-dimensional echocardiography did not (p=0.94). LA reservoir function, measured by strain, did not differ among the groups. Left ventricular (LV) size and function were not different among groups, except LV mass index. A decrease in E/A ratio and an increase in E/e’ ratio with advancing age (p<0.0001 and p=0.001, respectively).

Conclusions. In healthy subjects LA volume index is not influenced while LA antero-posterior diameter and absolute volumes increase with advancing age. Neither LA deformation nor systolic function measures were affected by age. Thus, an increase in LA volume index and a decrease in LA reservoir function should be considered as an expression of pathology rather than part of normal aging.

National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-135110 (URN)
Available from: 2017-05-18 Created: 2017-05-18 Last updated: 2017-05-19

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