Differing mechanisms of atrial fibrillation in athletes and non-athletes: alterations in atrial structure and function
| Autor: | Prashanthan Sanders, M. Darragh Flannery, Andre La Gerche, K. Janssens, Luke Stefani, Hein Heidbuchel, Siddharth J. Trivedi, Jonathan M. Kalman, Guido Claessen, Liza Thomas, Adrian D. Elliott, P. Brown |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Diastole Hemodynamics Catheter ablation 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine Atrial Fibrillation Medicine Humans Radiology Nuclear Medicine and imaging Diastolic function 030212 general & internal medicine Heart Atria Myopathy Computer. Automation Atrium (architecture) business.industry Atrial fibrillation General Medicine Atrial Remodeling medicine.disease Pathophysiology Athletes Cardiology Atrial Function Left Human medicine medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | European heart journal : cardiovascular Imaging |
| ISSN: | 2047-2412 2047-2404 |
| Popis: | Aims Atrial fibrillation (AF) is more common in athletes and may be associated with adverse left atrial (LA) remodelling. We compared LA structure and function in athletes and non-athletes with and without AF. Methods and results Individuals (144) were recruited from four groups (each n = 36): (i) endurance athletes with paroxysmal AF, (ii) endurance athletes without AF, (iii) non-athletes with paroxysmal AF, and (iv) non-athletic healthy controls. Detailed echocardiograms were performed. Athletes had 35% larger LA volumes and 51% larger left ventricular (LV) volumes vs. non-athletes. Non-athletes with AF had increased LA size compared with controls. LA/LV volume ratios were similar in both athlete groups and non-athlete controls, but LA volumes were differentially increased in non-athletes with AF. Diastolic function was impaired in non-athletes with AF vs. non-athletes without, while athletes with and without AF had normal diastolic function. Compared with non-AF athletes, athletes with AF had increased LA minimum volumes (22.6 ± 5.6 vs. 19.2 ± 6.7 mL/m2, P = 0.033), with reduced LA emptying fraction (0.49 ± 0.06 vs. 0.55 ± 0.12, P = 0.02), and LA expansion index (1.0 ± 0.3 vs. 1.2 ± 0.5, P = 0.03). LA reservoir and contractile strain were decreased in athletes and similar to non-athletes with AF. Conclusion Functional associations differed between athletes and non-athletes with AF, suggesting different pathophysiological mechanisms. Diastolic dysfunction and reduced strain defined non-athletes with AF. Athletes had low atrial strain and those with AF had enlarged LA volumes and reduced atrial emptying, but preserved LV diastolic parameters. Thus, AF in athletes may be triggered by an atrial myopathy from exercise-induced haemodynamic stretch consequent to increased cardiac output. |
| Databáze: | OpenAIRE |
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