Atrial chamber remodelling in healthy pre-adolescent athletes engaged in endurance sports: A study with a longitudinal design. The CHILD study
Introduction
The importance of assessing right (RA) and left atrial (LA) size by echocardiography in children has increasingly been recognized. Enlarged RA can provide relevant hints for the diagnosis, follow-up, and indication for intervention [1], [2], [3]. Also LA size is a recognized key determinant of cardiac function and recent evidence suggests that in childhood obesity independently influences LA size [4], [5] and may represent a possible marker of increased cardiovascular risk [5]. Biatrial enlargement is considered an early marker of ventricular disease, as well as physiological response to increases in loading conditions, as is the case in the ‘athlete's heart’ [6], [7], [8], [9]. While previous cross-sectional and longitudinal studies reported the impact of exercise on biatrial functional and dimensional remodelling in adults [10], [11], [12], little is known about respective changes in the growing heart in the early phases of sports careers. Data from adult studies cannot be directly transferred to preadolescent athletes, as they are physically less mature and are usually exposed to a shorter period of training compared to adults [13]. Furthermore, very few longitudinal studies have examined the effect of endurance training on cardiac measurements in preadolescent athletes [14], [15], [16], with controversial results. Considering the increasing number of children involved in sports, the trend to more intensive physical training, and the decreasing age at which young athletes are encouraged to train intensively for sporting competitions, a better understanding of their morphological and functional adaptation is extremely important and imposes the need for the clinical characterization of their response to exercise.
Therefore, the aim of this longitudinal study was: i) to evaluate potential differences in atrial measurements in preadolescent athletes under control conditions; ii) to assess the extent of increase in atrial measurements after 5 months of training compared to no training; and iii) to determine whether atrial changes are related to those of myocardial function assessed by speckle-tracking echocardiography (STE).
Section snippets
Study population
Sixty-two pre-adolescent male competitive endurance athletes practising swimming in a regional level of mean age 10.8 ± 0.2 years [9], [10], [11], [12], [13] were enrolled in this study. They were trained once a day, for 5–6 days a week. A typical training started with 30–45 min of dry-land exercises (gymnastics and stretching) followed by 75–90 min swimming. The total training programme consisted of 10% of warming-up exercises, 15% of technical training, and 75% of three-staged aerobic exercises. In
Results
The demographic characteristics of athletes and controls are reported in Table 1. At baseline there were no significant differences between athletes and controls for height, weight, and BSA. After 5 months, height, weight, and BSA all increased in both athletes and in controls (p < 0.0001 for both).
Based on the Tanner's Scale, 46% (n = 25) of athletes were at stage 1 (pre-puberty) and the rest were at stages 2–5 (puberty), at baseline. 9% (n = 5) of athletes had reached sexual maturity and 37%
Discussion
The present study is the first to longitudinally characterize biatrial response to training in preadolescent athletes. We demonstrated that: i) at baseline indexed biatrial structural measurements were not different between preadolescent athletes, evaluated after 3 months of detraining, and their sedentary counterparts; ii) after 5 months, LA size significantly increased in athletes and these findings were consistent irrespective of technique used (2D or 3D echocardiography); however, RA size did
Limitations
While the present study suggests that training can affect biatrial size and function in pre-adolescents, it is important to highlight that this finding may be sport specific, it is possible that the influence of age and the related hormonal and growth factors may have a different impact in anaerobic sports. Also, we cannot exclude that the observed response to training may reflect genetic traits which predisposed the trained children to a more favourable and relevant adaptation. Our results
Conclusions
Intensive endurance training affects the growing heart of preadolescent athletes with an additive increase in biatrial size, suggesting that morphological adaptations can occur also in the early phases of the sports career of an athlete. Five months of intensive training were associated with a preserved biatrial function, as demonstrated by two-dimensional STE and by 3-D echocardiographic measurements, supporting the hypothesis of a physiological remodelling of the heart. Although the presence
Conflict of interest disclosures
None.
Acknowledgments
The research was realized with a grant made available by the Italian Society of Cardiology, supported by a contribution of MSD Italy on behalf of MSD-ITALY MERCK SHARP & DOHME CORPORATION.
References (34)
- et al.
Left atrial size increases with body mass index in children
Int. J. Cardiol.
(2010) - et al.
Prevalence and clinical significance of left atrial remodeling in competitive athletes
J. Am. Coll. Cardiol.
(2005) - et al.
Left atrial volume index in highly trained athletes
Am. Heart J.
(2010) - et al.
Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy
J. Am. Coll. Cardiol.
(2002) - et al.
Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography
J. Am. Soc. Echocardiogr.
(2010) - et al.
Assessment of left atrial volume and function by real-time three-dimensional echocardiography
Int. J. Cardiol.
(2008) - et al.
Left atrial volume by real-time three-dimensional echocardiography: validation by 64-slice multidetector computed tomography
J. Am. Soc. Echocardiogr.
(2011) - et al.
Quantitative evaluation of right atrial volume and right atrial emptying fraction by 320-slice computed tomography compared with three-dimensional echocardiography
Int. J. Cardiol.
(2011) - et al.
Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers
J. Sci. Med. Sport
(2010) - et al.
Prognostic significance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension
Am. J. Cardiol.
(2013)
Right ventricular diastolic performance in children with pulmonary arterial hypertension associated with congenital heart disease: correlation of echocardiographic parameters with invasive reference standards by high-fidelity micromanometer catheter
Circ. Cardiovasc. Imaging
Echocardiography in pediatric pulmonary arterial hypertension: early study on assessing disease severity and predicting outcome
Circ. Cardiovasc. Imaging
Increased left atrial size in obese children and its association with insulin resistance: a pilot study
Eur. J. Pediatr.
Determinants of echocardiographic left atrial volume: implications for normalcy
Eur. J. Echocardiogr.
Supernormal diastolic function and role of left atrial myocardial deformation analysis by 2D speckle tracking echocardiography in elite soccer players
Echocardiography
Left atrial remodelling in competitive adolescent soccer players
Int. J. Sports Med.
Morphological and functional adaptation of left and right atria induced by training in highly trained female athletes
Circ. Cardiovasc. Imaging
Cited by (34)
The right ventricle in “Left-sided” cardiomyopathies: The dark side of the moon
2021, Trends in Cardiovascular MedicineThe effects of activity, body weight, sex and age on echocardiographic values in English setter dogs
2021, Journal of Veterinary CardiologyCitation Excerpt :The more active group had larger mean normalised LV diastolic dimension, larger mean LV systolic volume, larger mean LV systolic volume normalised to body surface area and BW, larger LV and interventricular wall thickness and lower ejection fraction than the less active group. Human studies show that endurance athletes commonly develop eccentric cardiomegaly as volume loading of the heart predominates, whereas power athletes, such as short distance runners and weightlifters, develop concentric cardiomegaly as an effect of surges in systolic blood pressure without substantial increases in cardiac output [43–45]. Our results suggest a mixture of these two scenarios.
The athlete’s heart: insights from echocardiography
2023, Echo Research and PracticeLong-Term Sports Practice and Atrial Fibrillation: An Updated Review of a Complex Relationship
2023, Journal of Cardiovascular Development and DiseaseHow to evaluate resting ECG and imaging in children practising sport: a critical review and proposal of an algorithm for ECG interpretation
2023, European Journal of Preventive CardiologyTraining intensity influences left ventricular dimensions in young competitive athletes
2022, Frontiers in Cardiovascular Medicine