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

Cesare Cuspidi, Carla Sala, Marijana Tadic, Giovanni Baccanelli, Elisa Gherbesi, Guido Grassi, Giuseppe Mancia

Research output: Contribution to journalReview article

Abstract

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/m 2 vs 22.2 ± 0.9 mL/m 2 ), 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.

Original languageEnglish
Pages (from-to)922-932
JournalScandinavian Journal of Medicine and Science in Sports
Volume29
Issue number7
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Athletes
Meta-Analysis
Heart Atria
Dilatation
Atrial Function
Publication Bias
PubMed
MEDLINE
Sports
Echocardiography
Language
Databases
Population

Keywords

  • athletes
  • atrial dilatation
  • echocardiography
  • left atrial volume

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Left atrial volume in elite athletes : A meta-analysis of echocardiographic studies. / Cuspidi, Cesare; Sala, Carla; Tadic, Marijana; Baccanelli, Giovanni; Gherbesi, Elisa; Grassi, Guido; Mancia, Giuseppe.

In: Scandinavian Journal of Medicine and Science in Sports, Vol. 29, No. 7, 01.01.2019, p. 922-932.

Research output: Contribution to journalReview article

Cuspidi, Cesare ; Sala, Carla ; Tadic, Marijana ; Baccanelli, Giovanni ; Gherbesi, Elisa ; Grassi, Guido ; Mancia, Giuseppe. / Left atrial volume in elite athletes : A meta-analysis of echocardiographic studies. In: Scandinavian Journal of Medicine and Science in Sports. 2019 ; Vol. 29, No. 7. pp. 922-932.
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AB - 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/m 2 vs 22.2 ± 0.9 mL/m 2 ), 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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