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Association of left atrial size and function and aerobic fitness in endurance athletes

Session Poster session 1

Speaker Nathan John Price

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Dimensions, Volumes and Mass
  • Session type : Poster Session

Authors : NJ Price (Leeds,GB), CE Saunderson (Leeds,GB), J O'neill (Leeds,GB), AK Mcdiarmid (Leeds,GB), B Erhayiem (Leeds,GB), L Miller (London,GB), A Malhotra (London,GB), S Sharma (London,GB), S Plein (Leeds,GB), JP Greenwood (Leeds,GB), PP Swoboda (Leeds,GB)

Authors:
NJ Price1 , CE Saunderson2 , J O'neill1 , AK Mcdiarmid2 , B Erhayiem2 , L Miller3 , A Malhotra3 , S Sharma3 , S Plein2 , JP Greenwood2 , PP Swoboda2 , 1Leeds Teaching Hospitals NHS Trust - Leeds - United Kingdom of Great Britain & Northern Ireland , 2University of Leeds - Leeds - United Kingdom of Great Britain & Northern Ireland , 3St George's University of London - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii89

Background

Endurance athletes have increased prevalence of atrial fibrillation (AF). Data from non-athletes suggest maximal left atrium (LA) volume and total emptying fraction predict future AF. We used cardiovascular magnetic resonance (CMR) to establish if these parameters differ between endurance athletes and sedentary controls and if they relate to aerobic fitness. 

Methods 

65 healthy endurance athletes (11 runners, 27 cyclists, 13 triathletes, 14 rowers) exercising >6 hours/week, aged 18-50, underwent CMR volumetric analysis of left atrial and ventricular size and function and aerobic fitness assessment by cardiopulmonary exercise testing. Sedentary controls (n=25) exercising <3 hours/week underwent identical CMR protocol. 

Results 

Athletes demonstrated greater LA volume index and lower LA total emptying fraction than sedentary controls. On univariable regression increasing age (p=0.001), male (p=0.005), years training (p=0.009) and VO2max (ml/kg/min) (p=0.006) were associated with greater LA volume. On multivariable regression only increasing age (p=<0.001) and VO2max (ml/kg/min) (p=<0.001) were associated with greater LA volume. Only increasing age was associated with decreased LA total emptying fraction (p=0.011).

Conclusions 

Endurance athletes have left atrial dilatation and impaired total emptying fraction compared to sedentary controls, which may be contributing factors to the development of AF. Greater aerobic fitness is associated with increased LA size but not total emptying fraction. Further studies are needed to establish if these parameters predict the risk of AF in endurance athletes.

Athlete Control P value
Age 32.5 ± 16 31.1 ± 13 0.742
Years Training 8 ± 11 - -
Training/week (hours) 12 ± 7 - -
VO2max (mL/kg/min) 56.9 ± 8.9 - -
LVEDVI (mL/m2) 112.6 ± 16.1 89.7 ± 15.6 <0.001
LV Ejection Fraction (%) 57.3 ± 5.3 56.6 ± 3.5 0.501
LVMI (g/m2) 71.1 ± 12.9 46.1 ± 9.4 <0.001
LAVImax (mL/m2) 61 ± 11.6 46.5 ± 8.2 <0.001
Passive LA Emptying Fraction (%) 35.1 ± 1.2 41.1 ± 9.5 0.011
Active LA Emptying Fraction (%) 27.5 ± 11.2 29.1 ± 15.1 0.571
Total LA Emptying Fraction (%) 53.3 ± 8 58.8 ± 8.5 0.005
EDVI=End diastolic volume index LAVI=Left atrium volume index LVMI=Left ventricle mass index

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