Chronic adaptation of atrial structure and function in elite male athletes

McClean, Gavin; George, Keith; Lord, Rachel; Utomi, Victor; Jones, Nigel; Somauroo, John; Fletcher, Sarah; Oxborough, David

doi:10.1093/ehjci/jeu215

Cited by 47 publications

(39 citation statements)

References 30 publications

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“…Average BSA ranged from 1.50 ± 0.30 m 2 to 2.0 ± 0.10 m 2 , (pooled mean 1.86 ± 0.03 m 2 ). Average office systolic BP ranged from 108 ± 11 mm Hg to 129 ± 18 mm Hg, diastolic BP from 67 ± 7 mm Hg to 81 ± 14 mm Hg (pooled mean values being 119.7 ± 0.8 and 75.0 ± 0.8 mm Hg, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Left atrial volume in elite athletes: A meta‐analysis of echocardiographic studies

Cuspidi

Sala

Tadić

et al. 2019

Scandinavian Med Sci Sports

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Aim Information on left atrium (LA) enlargement, as assessed by LA volume (LAV) instead of LA diameter, in the athletic population is scanty. To expand current knowledge on this issue, we performed an updated meta‐analysis of echocardiographic studies. Design The Ovid MEDLINE, PubMed, and Cochrane CENTRAL databases were searched for English language articles without time restriction up to February 2018 through focused, high sensitive search strategies. Studies were identified by crossing the following search terms: “athletes,” “physical training,” “left atrial size,” “left atrial volume,” “atrial function,” and “echocardiography.”. Results Overall, 3145 subjects (2425 elite athletes and 720 active but not trained healthy controls) were included in 16 studies. Average LAV indexed to BSA (LAVI) was 37% higher in athletes as compared to nonathletic controls (31.0 ± 1.4 mL/m2 vs 22.2 ± 0.9 mL/m2), the standard means difference (SMD) being 1.12 ± 0.13 (CI: 0.86‐1.89, P < 0.0001). SMD was higher in high‐dynamic/high‐static trained athletes (1.78 ± 0.24, CI: 1.30‐2.20, P < 0.001) than in high‐dynamic/low‐static trained athletes 1.00 ± 0.16, CI: 0.70‐1.30, P < 0.001). The statistical difference did not change after correction for publication bias and was not affected by a single study effect. Conclusions Our meta‐analysis suggests that the adaptation of LA to intensive physical training in elite athletes is characterized by a marked increase in LAVI; LA dilation is more pronounced in the subgroup of high‐dynamic/high‐static trained athletes. The functional and clinical implications related to advanced LA dilation in athletes and particularly in those engaged in high‐dynamic/high‐static disciplines deserve further investigations.

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Section: Resultsmentioning

confidence: 99%

“…All studies examined but two examined high‐dynamic trained athletes with different static component.…”

Section: Resultsmentioning

confidence: 99%

Left atrial volume in elite athletes: A meta‐analysis of echocardiographic studies

Cuspidi

Sala

Tadić

et al. 2019

Scandinavian Med Sci Sports

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“…8 The conduit to booster ratio (con:boo) was derived as a measure of relative contributions to diastolic filling. RAVOLcon was determined by difference between LV stroke volume (as this should equal RV stroke volume) (from Simpsons Biplane method) and RAVOLres.…”

Section: Right Atriummentioning

confidence: 99%

“…[3][4][5][6][7][8] RV enlargement is a common phenotype in AH but is also one of the diagnostic criteria for Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), a condition linked to sudden cardiac death (SCD). 1,2 Although the AH phenotype involves all cardiac chambers, the left ventricle (LV) has been the most extensively studied and reported in meta-analyses 1,2 with the impact of remodelling on the right ventricle (RV) and right atrium (RA) having received less attention.…”

Section: Introductionmentioning

confidence: 99%

The right heart of the elite senior rugby football league athlete

et al. 2019

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Background: Right heart enlargement is common in the athletes' heart phenotype; however, few data exist regarding interpretation of normal athletic adaptation during Preparticipation Cardiac Screening (PCS) of Rugby Football League (RFL) athletes.Echocardiography is utilized during PCS and thus the primary aim of this study was to establish the normal right ventricular (RV) phenotype in elite RFL athletes using standard 2-D echocardiography and myocardial mechanics. The secondary aim was to describe right atrial (RA) structure and function using 2-D echocardiography.Methods: 139 male RFL athletes underwent echocardiographic evaluation of the right heart including RV strain (ɛ) and strain rate (SR) imaging using speckle tracking echocardiography (STE). Nonathletic males were used for comparison and allometric scaling was applied for conventional echocardiographic parameters.Results: Scaled RV dimensions were larger in athletes (P < 0.05) with the exception of the mid-cavity. No differences (P > 0.05) in RV fractional area change (FAC) and RV longitudinal ɛ were observed between groups. Tissue Doppler imaging (TDI)-indexed parameters and global strain rate (SR) were lower (P < 0.05) in athletes with HR and weight found to have co-variance with SR. The RA was larger in athletes (P < 0.001) with no functional difference (P > 0.05) observed by volume assessment.Conclusions: Reduction in SR and indexed TDI are partly associated with lower HR and increased body mass and are likely to represent normal physiological adaptation in RFL athletes. RA enlargement appears proportional to RV enlargement. These data may aid interpretation of normal athletic adaptation during PCS of RFL athletes. K E Y W O R D Sathletes' heart, echocardiography, right heart, strain | 889 FORSYTHE ET al.

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“…3D imaging of the RV is now feasible, and hence, RV ejection fraction and 3D strain are becoming part of the noninvasive armamentarium.Although RV size did not show any strong association with outcome, it is clear that a 3D technique would allow for a more detailed understanding of complex RV remodeling (9). It is also apparent that these tools have recently been applied to the RA(10,11), and therefore, a greater depth of knowledge pertaining to the RA-RV relationship is rapidly becoming reality.The next logical step should aim to use the advances in echocardiography without detracting from the "simple" nature of the index. It is important to commend Haddad et al(6) for this work and for reminding us that "simple" can still reflect complexity but also to be aware that any index needs to be sensitive to responses to therapy and disease progression while remaining valid and reproducible.REPRINT REQUESTS AND CORRESPONDENCE: Dr. David Oxborough, Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool L3 3AF, UnitedKingdom.…”

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confidence: 99%

Predicting Mortality in Pulmonary Arterial Hypertension

Oxborough

Lord

2015

JACC: Cardiovascular Imaging

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E chocardiography plays an important role in the diagnosis and monitoring of cardiac structure and function in patients with pulmonary arterial hypertension (PAH) (1). The routine application of resting echocardiography allows for the noninvasive assessment of pulmonary and right ventricular (RV) pressures, as well as the determination of the progression of (mal)adaptive remodeling of the RV cavity (2). Although there is a clear link between the severity of the disease and the extent of RV remodeling, there is limited evidence to suggest that echocardiography alone has prognostic value. Some large studies have attempted to develop a predictive model for mortality risk stratification in PAH and established that echocardiography is mainly redundant. In 1991, the National Institutes of Health provided the first prognostic equation; however, in view of changes in disease classifications and an advancement in both therapy and technology, the REVEAL (Registry to Evaluate Early and Long-Term PAH Disease Management) study in 2010 (3) provided a more up-to-date mortality risk stratification model for PAH. This model utilizes a range of demographic, clinical, and diagnostic criteria, providing reasonable sensitivity and specificity. That aside, the criteria are numerous and the model is complex, requiring the use of multiple investigations with little reliance on the structural or functional remodeling of the RV. Furthermore, a relatively recent statement from the American College of Cardiology Foundation stated that echocardiography alone holds little predictive value (4). From a pathophysiological viewpoint, these findings appear somewhat surprising. PAH leads to what we consider a right heart failure syndrome, and therefore we would expect the degree of RV remodeling and dysfunction to be directly linked to mortality, as is the case in left-sided heart failure. In addition, exercise limitation is a strong predictor of prognosis in PAH (2), whereas right ventricular failure contributes significantly to reduced exercise tolerance primarily through a reduced cardiac index but also secondary to peripheral fluid retention.The disparity between what we expect and what we observe should lead one to question the validity of the applied measurements. In this setting, the applied measurements relate to the assessment of right heart structure and function. It is feasible that previous work has failed to acknowledge the complex holistic nature of the right heart and the interaction between the right atrium (RA) and the RV. Moreover, the complex shape of the RV and its fiber alignment dictates equally complex mechanics. RV function is influenced by a range of factors, including those that affect preload and afterload, such as respiration, gravity, pulmonary vascular resistance, and direct factors related to the structural integrity of the rightsided myocardium, such as intrinsic contractility, relaxation, and compliance (5). In the presence of an acute increase in RV afterload, the workload of the ventricle increases, causing prolon...

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Chronic adaptation of atrial structure and function in elite male athletes

Cited by 47 publications

References 30 publications

Left atrial volume in elite athletes: A meta‐analysis of echocardiographic studies

Left atrial volume in elite athletes: A meta‐analysis of echocardiographic studies

The right heart of the elite senior rugby football league athlete

Predicting Mortality in Pulmonary Arterial Hypertension

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