Morphological and Functional Adaptation of Left and Right Atria Induced by Training in Highly Trained Female Athletes
Background—Exercise is able to induce atrial remodelling in top-level athletes. However, evidence is mainly limited to men and based on cross-sectional studies. The aim of this prospective, longitudinal study was to investigate whether exercise is able to influence left (LA) and right atrial (RA) morphology and function also in female athletes.
Methods and Results—Two-dimensional echocardiography was performed pre-season and after 16 weeks of intensive training in 24 top-level female athletes. LA and RA myocardial deformation was assessed by 2D speckle-tracking echocardiography. LA volume index (24.0±3.6 vs. 26.7±6.9 mL/m2, p<0.001) and RA volume index (15.66±3.09 vs. 20.47±4.82 mL/m2, p<0.001) significantly increased after training in female athletes. LA global peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) significantly decreased after training in female athletes (43.9±9.5% vs. 39.8 ± 6.5%, p<0.05; 15.5±4.0% vs. 13.9±4.0%, p<0.05, respectively). RA PALS and PACS showed a similar, although not significant, decrease (42.8±10.6% vs. 39.3±8.3%; 15.6±5.6% vs. 13.1±6.1%, respectively). Neither biventricular E/e' ratio nor biatrial stiffness changed after training, suggesting that biatrial remodelling occurs in a model of volume rather than pressure overload.
Conclusions—Exercise is able to induce biatrial morphological and functional changes in female athletes. Biatrial enlargement, with normal filling pressures and low atrial stiffness, is a typical feature of athlete's heart in women. These findings should be interpreted as physiological adaptations to exercise and should be considered in the differential diagnosis with cardiomyopathies.
- Received June 12, 2013.
- Accepted January 16, 2014.