CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 109 Assessment of left atrial morphological and functional differences in professional male football players: a prospective, case–control study Sefa Gül, Hasan Güngör Abstract Background: Intensive physical activity in athletes leads to considerable changes in the morphology and physiology of the left atrium through physiological, exercise-induced remodelling. Aim: This study aimed to assess the mechanical and electrophysiological changes in professional football players using electrocardiographic and echocardiographic assessment tools. Methods: This prospective, case–control study was performed between February and June 2022. The population consisted of elite male football players (n = 49, group F) as the study group, and healthy male non-athlete individuals of matching age (n = 50, group C) as the control group. All participants underwent electrocardiographic and echocardiographic (two-dimensional and tissue Doppler) examinations. Volumetric and functional assessment of the left atrium was identified as the study’s primary outcome. Results: There was no significant difference between the groups in terms of demographic and morphometric characteristics (p > 0.05). Maximum and minimum P waves and PR-interval duration were significantly higher in group F than in group C (p = 0.011, p = 0.005 and p < 0.001). Diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes were significantly increased in group F (p < 0.0). Ejection fraction of the left atrium was significantly lower in group F than in group C (p = 0.001). Pulmonary acceleration time and tricuspid annular plane systolic excursion was significantly higher in the football players (p = 0.023 and p < 0.001). Conclusions: Increased diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes could be demonstrated in the elite football players. The morphological and functional changes in the left atrium might be a physiological consequence of left atrial cardiac remodelling to intensive and chronic training. Keywords: athlete’s heart, Doppler echocardiography, electrocardiography, left atrium, 2D echocardiography Submitted 29/8/22, accepted 27/2/23 Published online 22/3/23 Cardiovasc J Afr 2023; 34: 109–113 www.cvja.co.za DOI: 10.5830/CVJA-2023-010 Athlete’s heart is a term used to imply the physiological adaptations that occur in athletes to meet the requirement of higher cardiac output during intensive training.1-4 Various adaptive mechanisms, including symmetrical and harmonic increases in intracavitary diameters and wall thickness, have been reported,1,2 depending on the mode, intensity, duration and volume of the training.5,6 Such progressive morphological and functional cardiovascular changes may regress upon the interruption of physical activities or negatively affect the future physical capacity of the athletes.2 There are different classifications of physical performance based on the intensity of exercises required for various sports. Fast sprints and physical endurance for 90 minutes are essential for football players. In this context, elite football players are categorised as low-static/high-dynamic or endurance athletes.1 Such isotonic–isometric dynamic and static muscular activities cause a decrease in both systemic arterial resistance and venous return and increase the intracavitary dimensions and systolic output.2 In addition to the nature of the physical activity, the eccentric ventricular hypertrophy correlated to body size and exercise intensity is the primary adaptive, exercise-induced remodelling seen in athletes.2,5-7 The left ventricle (LV) has been the most frequently studied cardiac chamber in studies focused on athletes.2 4,8 On the other hand, recent studies have evaluated the atrial reservoir, conduit and pump function phases.1,9,10 The dilatation of the left atrium (LA) and prolonged PQ time is the most commonly observed structural and physiological adaptation forms in athletes involved in endurance sport such as football.4,11-17 There are no well-established normal upper limits of the cardiac chambers in athletes that could otherwise be used to define any atrial or ventricular dilatation.1 In addition, there is also no study in the literature that addresses athletes’ electromechanical changes with LA dilatation in detail. In the light of the foregoing, it was hypothesised that intensive physical activity will lead to changes in the morphology and physiology of the LA of athletes. Based on this hypothesis, the objective of this study was to evaluate the morphological and electrophysiological alterations in professional football players via echocardiographic assessments, compared to the non-athlete control subjects. Methods This study was designed as a prospective, case–control study to assess elite football players’ LA mechanical and electrophysiological function. The study protocol was approved by the local ethics committee (Samsun Training and Research Hospital Ethics Committee, approval date: 02/02/2022, approval number: 2022/2/11). The study was carried out in accordance Department of Cardiology, Samsun Training and Research Hospital, Samsun, Turkey Sefa Gül, MD, sefagul.dr@gmail.com Department of Cardiology, Faculty of Medicine Hospital, Aydin Adnan Menderes University, Aydin, Turkey Hasan Güngör, MD
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