In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
Left atrial morphological and electrical remodeling in athletes: a prospective, longitudinal combined ECG and speckle-tracking study
Authors : F D'ascenzi (Siena,IT), M Solari (Siena,IT), M Focardi (Siena,IT), M Cameli (Siena,IT), M Biagi (Siena,IT), F Cassano (Siena,IT), D Corrado (Padua,IT), M Bonifazi (Siena,IT), S Mondillo (Siena,IT), M Henein (Umea,SE)
1University of Siena, Department of Cardiovascular Diseases - Siena - Italy
2University of Padova, Department of Cardiac, Thoracic, and Vascular Sciences, - Padua - Italy
3University of Siena, Department of Medicine, Surgery, and NeuroScience - Siena - Italy
4Umea University Hospital, Department of Cardiology - Umea - Sweden
Background: Biatrial enlargement is common in athletes and a further increase in biatrial size can occur in response to training. P-wave morphology seems to be unaffected by atrial size, however a few studies have been conducted and longitudinal data is not available. The aim of this study was to prospectively investigate whether the morphological biatrial adaptation to exercise corresponds to electrical changes of resting 12-lead ECG.
Methods: Thirty-three competitive athletes were evaluated at the beginning and after 6 months of training by ECG and by standard and 2D speckle-tracking echocardiography. Twenty-two sedentary subjects served as controls.
Results: Athletes had greater left atrial (LA) and right atrial (RA) size compared with controls (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. Only 6% of athletes fulfilled the ECG criteria for LA enlargement, with no difference from controls (p=0.23). Despite further increase in LA size after training, this percentage remained unchanged. Biatrial stiffness was normal in athletes both before and after training.
Conclusions: An intensive, high-volume training program causes significant increase in LA and RA 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, in young healthy athletes is not related to atrial size.
LA volume index, mL/m2
RA volume index, mL/m2
LA enlargement criteria
RA enlargement criteria
†Athletes vs. controls; ‡pre-training vs. post-training.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
Our mission: To reduce the burden of cardiovascular disease