Document Detail


Prevalence and clinical significance of left atrial remodeling in competitive athletes.
MedLine Citation:
PMID:  16098437     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: In the present study we assessed the distribution and clinical significance of left atrial (LA) size in the context of athlete's heart and the differential diagnosis from structural heart disease, as well as the proclivity to supraventricular arrhythmias. BACKGROUND: The prevalence, clinical significance, and long-term arrhythmic consequences of LA enlargement in competitive athletes are unresolved. METHODS: We assessed LA dimension and the prevalence of supraventricular tachyarrhythmias in 1,777 competitive athletes (71% of whom were males), free of structural cardiovascular disease, that were participating in 38 different sports. RESULTS: The LA dimension was 23 to 50 mm (mean, 37 +/- 4 mm) in men and 20 to 46 mm (mean, 32 +/- 4 mm) in women and was enlarged (i.e., transverse dimension > or = 40 mm) in 347 athletes (20%), including 38 (2%) with marked dilation (> or = 45 mm). Of the 1,777 athletes, only 14 (0.8%) had documented, symptomatic episodes of either paroxysmal atrial fibrillation (n = 5; 0.3%) or supraventricular tachycardia (n = 9; 0.5%), which together occurred in a similar proportion in athletes with (0.9%) or without (0.8%; p = NS) LA enlargement. Multivariate regression analysis showed LA enlargement in athletes was largely explained by left ventricular cavity enlargement (R2 = 0.53) and participation in dynamic sports (such as cycling, rowing/canoeing) but minimally by body size. CONCLUSIONS: In a large population of highly trained athletes, enlarged LA dimension > or = 40 mm was relatively common (20%), with the upper limits of 45 mm in women and 50 mm in men distinguishing physiologic cardiac remodeling ("athlete's heart") from pathologic cardiac conditions. Atrial fibrillation and other supraventricular tachyarrhythmias proved to be uncommon (prevalence < 1%) and similar to that in the general population, despite the frequency of LA enlargement. Left atrial remodeling in competitive athletes may be regarded as a physiologic adaptation to exercise conditioning, largely without adverse clinical consequences.
Authors:
Antonio Pelliccia; Barry J Maron; Fernando M Di Paolo; Alessandro Biffi; Filippo M Quattrini; Cataldo Pisicchio; Alessandra Roselli; Stefano Caselli; Franco Culasso
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  46     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-15     Completed Date:  2005-09-13     Revised Date:  2006-06-27    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  690-6     Citation Subset:  AIM; IM    
Affiliation:
National Institute of Sports Medicine, Italian National Olympic Committee, Rome, Italy. ant.pelliccia@libero.it
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MeSH Terms
Descriptor/Qualifier:
Adaptation, Physiological
Adolescent
Adult
Atrial Fibrillation / epidemiology*,  ultrasonography
Diagnosis, Differential
Echocardiography
Female
Heart Atria / physiopathology*,  ultrasonography
Humans
Italy / epidemiology
Male
Prevalence
Sports / physiology*
Tachycardia, Supraventricular / epidemiology*,  ultrasonography
Ventricular Remodeling / physiology*
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2006 Jun 6;47(11):2340-1   [PMID:  16750709 ]
J Am Coll Cardiol. 2006 Jun 6;47(11):2341-2; author reply 2342   [PMID:  16750712 ]
J Am Coll Cardiol. 2006 Jun 6;47(11):2340   [PMID:  16750711 ]

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