Introduction: Physiological cardiac remodeling in elite athletes has been extensively described for the ventricles, but less is known regarding atrial function and its relationship with cardiorespiratory fitness. Objectives: This study aimed to evaluate right (RA) and left atrial (LA) strain in Olympic athletes, exploring sex and sport-specific differences and correlations with VO2 max. Methods: We enrolled 657 Olympic athletes (mean age 25.5±5.3 years; 51.7% male). All athletes underwent transthoracic echocardiography, including atrial strain analysis by 2D-STE and cardiopulmonary exercise test (CPET). Atrial reservoir (S_R), conduit (S_Cd) and contraction (S_Co) strain were measured. Athletes were grouped by sport discipline (skill, power, mixed, endurance). Results: Endurance athletes exhibited the largest atrial dimensions and the highest VO2 max (p<0.0001), and showed reduced RA S_R (34.9±9.1%, p<0.0001), S_Cd (-25.7±8.1%, p=0.0001) and S_Co (-9±4.4%, p=0.0006) and LA S_R (38±7.5%, p=0.048) compared to skill, power and mixed. No differences in LA S_Cd (p=0.07) and S_Co emerged (p=0.111). RA strain inversely correlated with VO2 max (p<0.0001), while no such relationship was observed for LA. Sex differences were observed, with males displaying larger atria (LAVi 23.9±7.8 ml/m2 vs. 22.3±6.3 ml/m2, p=0.004) but lower S_R and S_Cd compared to females (p<0.05). Conclusions: Functional atrial indexes (S_R, S_Cd and S_Co) appear more markedly altered in the atria of the less remodeled ventricles (more in skill than in endurance athletes) and even more in RA than in LA. Furthermore, male athletes demonstrated higher reservoir and conduit strain values, while females exhibited enhanced contractile function. Our results should be viewed in conjunction with the extent of ventricular remodeling, i.e., the more enlarged and performant (suction and contraction) the ventricular cavity is, the less relevant is the atrial contribution to filling.
Right and Left Atrial Strain by Speckle Tracking Echocardiography: Sex Differences and Correlation with Cardiorespiratory Fitness in Olympic Athletes / Di Gioia, Giuseppe; Ferrera, Armando; Squeo, Maria Rosaria; Spera, Francesco Raffaele; Maestrini, Viviana; Monosilio, Sara; Mango, Federica; Paoletti, Giulia; Serdoz, Andrea; Pelliccia, Antonio. - In: JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY. - ISSN 0894-7317. - (2025). [10.1016/j.echo.2025.09.002]
Right and Left Atrial Strain by Speckle Tracking Echocardiography: Sex Differences and Correlation with Cardiorespiratory Fitness in Olympic Athletes
Ferrera, Armando;Squeo, Maria Rosaria;Spera, Francesco Raffaele;Maestrini, Viviana;Monosilio, Sara;Mango, Federica;Serdoz, Andrea;
2025
Abstract
Introduction: Physiological cardiac remodeling in elite athletes has been extensively described for the ventricles, but less is known regarding atrial function and its relationship with cardiorespiratory fitness. Objectives: This study aimed to evaluate right (RA) and left atrial (LA) strain in Olympic athletes, exploring sex and sport-specific differences and correlations with VO2 max. Methods: We enrolled 657 Olympic athletes (mean age 25.5±5.3 years; 51.7% male). All athletes underwent transthoracic echocardiography, including atrial strain analysis by 2D-STE and cardiopulmonary exercise test (CPET). Atrial reservoir (S_R), conduit (S_Cd) and contraction (S_Co) strain were measured. Athletes were grouped by sport discipline (skill, power, mixed, endurance). Results: Endurance athletes exhibited the largest atrial dimensions and the highest VO2 max (p<0.0001), and showed reduced RA S_R (34.9±9.1%, p<0.0001), S_Cd (-25.7±8.1%, p=0.0001) and S_Co (-9±4.4%, p=0.0006) and LA S_R (38±7.5%, p=0.048) compared to skill, power and mixed. No differences in LA S_Cd (p=0.07) and S_Co emerged (p=0.111). RA strain inversely correlated with VO2 max (p<0.0001), while no such relationship was observed for LA. Sex differences were observed, with males displaying larger atria (LAVi 23.9±7.8 ml/m2 vs. 22.3±6.3 ml/m2, p=0.004) but lower S_R and S_Cd compared to females (p<0.05). Conclusions: Functional atrial indexes (S_R, S_Cd and S_Co) appear more markedly altered in the atria of the less remodeled ventricles (more in skill than in endurance athletes) and even more in RA than in LA. Furthermore, male athletes demonstrated higher reservoir and conduit strain values, while females exhibited enhanced contractile function. Our results should be viewed in conjunction with the extent of ventricular remodeling, i.e., the more enlarged and performant (suction and contraction) the ventricular cavity is, the less relevant is the atrial contribution to filling.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
