BACKGROUND Data are scarce regarding left atrial (LA) adaptation to regular physical exercise. The aim of this study was to examine left ventricular (LV) and also LA morphologic and functional remodeling in elite athletes using three-dimensional (3D) echocardiography. METHODS In this retrospective analysis, the study group consisted of 138 elite athletes (mean age, 20 ± 4 years; 62% men) and 50 sedentary control subjects. Electrocardiographically gated full-volume 3D data sets were obtained for offline analysis using dedicated software for 3D LA and LV measurements. Body surface area-indexed LA maximal volume (LAVmax) and LV end-diastolic volume were determined. LA total emptying fraction, LA passive and LA active emptying fraction, and LV global longitudinal strain were also calculated. Athletes also underwent cardiopulmonary exercise testing to determine peak oxygen uptake. RESULTS Athletes demonstrated higher 3D LAVmax (32 ± 6 vs 26 ± 8 mL/m2) and indexed LV end-diastolic volume (85 ± 12 vs 62 ± 10 mL/m2) compared with control subjects (P < .001 for both). Functional measures of the left ventricle and left atrium, such as the absolute value of 3D LV global longitudinal strain (19 ± 2% vs 22 ± 2%), LA total emptying fraction (58 ± 6% vs 64 ± 6%), and active emptying fraction (24 ± 10% vs 32 ± 10%) were lower in athletes (P < .001 for all). Male athletes had higher indexed LV end-diastolic volume compared with female athletes (89 ± 13 vs 80 ± 8 mL/m2, P < .001), but LAVmax did not differ between genders (32 ± 6 vs 33 ± 5 mL/m2, P = .18). Besides heart rate, gender, and body surface area, 3D LAVmax, LV global longitudinal strain, and LA passive emptying fraction were independent predictors of peak oxygen uptake. CONCLUSIONS Regular physical exercise results in marked LA and LV remodeling with considerable gender differences as explored by 3D echocardiography. In contrast with various cardiovascular diseases, more pronounced LA dilation and lower resting functional measures are associated with better exercise performance.

中文翻译：

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优秀运动员的心脏重塑与运动能力之间的关系：左心房形态和功能的三维超声心动图评估增量值。

背景技术关于左心房（LA）对常规体育锻炼的适应性的数据很少。这项研究的目的是使用三维（3D）超声心动图检查精英运动员的左心室（LV）以及LA形态和功能重塑。方法在这项回顾性分析中，研究组由138名精英运动员（平均年龄20±4岁； 62％的男性）和50名久坐的对照组组成。使用专用的3D LA和LV测量软件，获得了心电门控全体积3D数据集，以进行离线分析。确定了体表面积指数的LA最大容积（LAVmax）和LV舒张末期容积。还计算了LA总排空分数，LA被动和LA主动排空分数以及LV全局纵向应变。运动员还进行了心肺运动测试，以确定峰值摄氧量。结果与对照受试者相比，运动员表现出更高的3D LAVmax（32±6 vs 26±8 mL / m2）和索引的舒张末期容积（85±12 vs 62±10 mL / m2）（两者均P <.001）。左心室和左心房的功能指标，例如3D LV全局纵向应变的绝对值（19±2％vs 22±2％），LA总排空分数（58±6％vs 64±6％），以及运动员的主动排空分数（24±10％对32±10％）较低（所有人的P <0.001）。男性运动员的左室舒张末期容积指数高于女性运动员（89±13 vs 80±8 mL / m2，P <.001），但不同性别的LAVmax无差异（32±6 vs 33±5 mL / m2） ，P = .18）。除了心率，性别和身体表面积，3D LAVmax，LV总体纵向应变和LA被动排空分数是峰值摄氧量的独立预测因子。结论3D超声心动图发现，定期体育锻炼会导致明显的LA和LV重塑，并且存在明显的性别差异。与各种心血管疾病相反，更明显的LA扩张和较低的休息功能指标与更好的运动表现有关。