Di Gioia Giuseppe, Squeo Maria Rosaria, Ferrera Armando, Monosilio Sara, Mango Federica, Ortolina Davide, Maestrini Viviana, Spera Francesco Raffaele, Pelliccia Antonio
Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, Rome, 00197, Italy.
Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, Rome, 15- 00135, Italy.
Int J Cardiovasc Imaging. 2025 Aug 27. doi: 10.1007/s10554-025-03503-w.
Although athlete's heart is typically characterized by balanced enlargement of all cardiac chambers, previous investigations have placed relatively little focus on specific characteristics of atrial remodeling. The aim of our study is to describe cardiac remodeling in a cohort of elite endurance athletes, with a specific focus on atrial remodeling. Endurance athletes with unremarkable cardiovascular pre-participation screening test results underwent thorough multidisciplinary cardiovascular evaluation, which included transthoracic echocardiography. Atrial remodeling was defined as LAVi > 34 mL/m, and ventricular eccentric remodeling as LVMi > 115 g/m in male or > 95 g/m in female and RWT ≤0.42. 396 athletes were enrolled (mean age 26.4±5.1 years, 58.1% males). According to cardiac remodeling, athletes were classified into four groups: those with both left atrio-ventricular (A-V) remodeling (12.9%), athletes with isolated LV remodeling (43.9%), athletes with predominant LA remodeling (4%) and subjects with no cardiac remodeling (39.1%). Mean LAVi of athletes with NO A-V remodeling, ventricular remodeling, atrial remodeling, and A-V remodeling were respectively: 22.7±5.2 ml/m2, 24.1±5 ml/m2, 39.2±4.2 ml/m2, and 39.2±4.3 ml/m2 (p < 0.0001). No differences in atrial functional parameters were found among the four group (LA expansion index, p = 0.0645 and LA strain parameters p > 0.1). No significant differences were found in diastolic and systolic LV function (E/E', p = 0.191; E/A, p = 0.131; EF%, p = 0.517; LV GLS, p = 0.186) and in SVEB (p = 0.790). In elite endurance athletes a spectrum of cardiac remodeling is broader than usually described, ranging from the absence of evident structural changes to classic remodeling, with some cases exhibiting predominant atrial remodeling. This pattern was not associated with impaired atrial or ventricular function, nor with an increased incidence of atrial arrhythmias. Therefore, it could be considered a non-classical variant of the athlete's heart.
尽管运动员心脏的典型特征是所有心腔均呈对称性扩大，但以往的研究相对较少关注心房重塑的具体特征。我们研究的目的是描述一组优秀耐力运动员的心脏重塑情况，尤其关注心房重塑。心血管参与前筛查测试结果无异常的耐力运动员接受了全面的多学科心血管评估，包括经胸超声心动图检查。心房重塑定义为左心房容积指数（LAVi）>34 mL/m²，心室离心性重塑定义为男性左心室质量指数（LVMi）>115 g/m²或女性>95 g/m²且相对壁厚度（RWT）≤0.42。共纳入396名运动员（平均年龄26.4±5.1岁，58.1%为男性）。根据心脏重塑情况，运动员被分为四组：既有左房室（A-V）重塑的运动员（12.9%）、仅有左心室（LV）重塑的运动员（43.9%）、以左心房（LA）重塑为主的运动员（4%）和无心脏重塑的受试者（39.1%）。无A-V重塑、心室重塑、心房重塑和A-V重塑的运动员的平均LAVi分别为：22.7±5.2 ml/m²、24.1±5 ml/m²、39.2±4.2 ml/m²和39.2±4.3 ml/m²（p<0.0001）。四组之间心房功能参数无差异（左心房扩张指数，p=0.0645；左心房应变参数，p>0.1）。左心室舒张和收缩功能（E/E'，p=0.191；E/A，p=0.131；射血分数%，p=0.517；左心室整体纵向应变，p=0.186）和室性早搏（SVEB，p=0.790）均无显著差异。在优秀耐力运动员中，心脏重塑的范围比通常描述的更广，从无明显结构变化到经典重塑，有些病例表现为以心房重塑为主。这种模式与心房或心室功能受损无关，也与房性心律失常的发生率增加无关。因此，它可被视为运动员心脏的一种非经典变体。
