Acute, Exercise Dose–Dependent Impairment in Atrial Performance During an Endurance Race
abstract
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Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVES
This study sought to understand and characterize the acute atrial response to endurance exercise and the influence of the amount of exercise performed.
BACKGROUND
Endurance exercise seems to be recognized as a risk factor for developing atrial arrhythmia. Atrial geometrical and functional remodeling may be the underlying substrate.
METHODS
Echocardiography was performed in 55 healthy adults at baseline and after a 3-stage trail race: a short race (S) (14 km), n = 17; a medium race (M) (35 km), n = 21; and a long race (L) (56 km), n = 17. Analysis consisted of standard, speckle-tracking assessment of both the left ventricle (LV) and right ventricle (RV) and both the left atrium (LA) and the right atrium (RA): a-wave strain (Sa) and strain rate (Ra) as a surrogate for atrial contractile function and s-wave strain (St) and strain rate (SR) as reservoir function.
RESULTS
After the race, RA reservoir function decreased in group M (Δ% SRs: -12.5) and further in group L (Δ% SRs: -15.4), with no changes in group S. RA contractile function decreased in group L (Δ% SRa: -9.3), showed no changes in group M (Δ% SRa: +0.7), and increased in group S (Δ% SRa: +14.8). A similar trend was documented in LA reservoir and contractile function but with less pronounced changes. The decrease in RA reservoir after the race correlated with the decrease in RV global longitudinal strain (GLS) (Δ% RVGLS vs. RASt and RASRs: +0.44; p < 0.05 and +0.41, respectively; p < 0.05).
CONCLUSIONS
During a trail-running race, an acute exercise-dose dependent impairment in atrial function was observed, mostly in the RA, which was related to RV systolic dysfunction. The impact on atrial function of long-term endurance training might lead to atrial remodeling, favoring arrhythmia development.
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Additional Info
Disclosure statements are available on the authors' profiles:
Acute, Exercise Dose-Dependent Impairment in Atrial Performance During an Endurance Race: 2D Ultrasound Speckle-Tracking Strain Analysis
JACC Cardiovasc Imaging 2016 Dec 01;9(12)1380-1388, M Sanz-de la Garza, G Grazioli, BH Bijnens, SI Sarvari, E Guasch, C Pajuelo, D Brotons, E Subirats, R Brugada, E Roca, M SitgesFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
There is growing consensus that atrial fibrillation is more frequent in lifelong endurance athletes. The causes of this increased risk are unclear. Sanz-de la Garza and colleagues used echocardiography to examine ventricular and atrial function after endurance trail races of varying duration. Echocardiographic parameters were obtained in 17 runners after a 14-km trail race (short race), in 21 runners after a 35-km trail race (medium race), and in 17 runners after a 56-km trail race (long race). A wave strain and strain rate were measured as an indicator of atrial contractile function. S-wave strain and strain rate were measured as an indicator of atrial reservoir function.
Right atrial reservoir function did not change after the short race but decreased after the medium and long races. Right atrial contractile function decreased after the long race but did not change after the medium race and increased after the short race. The decrease in right atrial reservoir function after the races correlated directly with the decrease in right ventricular global longitudinal strain. There were similar trends for decreases in function in left atrial reservoir and contractile parameters, but these were less pronounced than those on the right.
The authors conclude that the effects of endurance running are more pronounced on the right than left atrium and that these changes are related to changes in right ventricular systolic function. They postulate that right atrial changes induced by exercise leads to right atrial remodeling, which contributes to the increase in atrial arrhythmias in athletes. These changes in atrial function are related to the exercise dose and decreases in right ventricular function with exercise.
This study is one of many recent reports emphasizing that changes in cardiac function with exercise are more pronounced on the right heart probably because the increase in pulmonary arterial pressure with exercise relative to rest is greater than that in the systemic circulation. This leads to a greater relative increase in right ventricular strain and right ventricular dysfunction. This in turn may affect right atrial function.
How the observed changes in right atrial stress contribute to atrial fibrillation in athletes, which is generally of left atrial origin, is unclear. Similar exercise effects probably occur in the left atrium, but may require greater degrees of exercise stress to be manifest. At present, these results have little clinical utility but they are interesting and may contribute to our understanding of the effects of exercise on cardiovascular function.