Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Abstract

Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women). All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001). Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%). We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

Sex-Specific Impacts of Exercise on Cardiovascular Remodeling

“…The atrial enlargement, which is dynamic and reversible, is an adaptive mechanism in response to the increased training-induced volume overload, and it may vary by sex. In a study consisting of young elite rowers (46.5% women), LA enlargement was found more frequently in men than in women [75]. Similar to the LA, greater right atrium (RA) dimensions were observed in elite athletes compared to sedentary control subjects [76].…”

Polymorphisms in<i> ACE</i> and <i>ACTN3</i> Genes and Blood Pressure Response to Acute Exercise in Elite Male Athletes from Serbia

“…Regular and intense physical activity leads to several morphological and functional adaptive heart modifications that have been known as "athlete's heart" (Król et al 2016). The extent of these physiological cardiovascular "adaptive" changes is predominantly related to the intensity and type of sport activity and highly depends on the type of physical training (Santoro et al 2014).…”

A Vegan Athlete’s Heart—Is It Different? Morphology and Function in Echocardiography

“…Even in athletes with advanced atrial remodelling, the left atrial function remains normal, similarly to the left ventricle. Moreover, it has been shown that left atrial volume correlated with exercise capacity in professional athletes [ 30 , 31 ].…”