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Left atrial morphological and electrical remodeling in athletes: a prospective, longitudinal combined ECG and speckle-tracking study

Session Poster session 3

Speaker Assistant Professor Flavio D'Ascenzi

Event : ESC Congress 2015

  • Topic : preventive cardiology
  • Sub-topic : Sports Cardiology
  • Session type : Poster Session

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)

F. D'Ascenzi1 , M. Solari1 , M. Focardi1 , M. Cameli1 , M. Biagi1 , F. Cassano1 , D. Corrado2 , M. Bonifazi3 , S. Mondillo1 , M. Henein4 , 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 ,

European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 464

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.

Table 1
VariableControlsCompetitive athletesP valueP value
LA volume index, mL/m220.7±4.727.1±6.631.1±8.20.0000.000
RA volume index, mL/m217.3±3.823.4±6.326.4±6.40.0000.005
LA enlargement criteria0%6%6%0.231.0
RA enlargement criteria0%0%0%1.01.0
Athletes vs. controls; pre-training vs. post-training.

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