CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 111 p = 0.005, respectively). In addition, the median duration of the PR interval in group F was significantly longer than in group C (148 vs 127.5 ms, p < 0.001). There were also significant differences between the groups in echocardiographic parameters (Table 3). Accordingly, the diameters of LV end-systolic and diastolic dimensions and the aortic root diameter were significantly more prominent in the elite football players (group F) (p = 0.011, p = 0.004 and p = 0.012, respectively). The LA diameters in group F and group C were 33.0 ± 3.0 and 29.6 ± 2.8 mm, respectively, indicating a statistically significant difference between the groups (p < 0.001). The groups also differed significantly in the echocardiographic measurements regarding volume and atrial function (Table 3). Accordingly, the maximum and minimum volumes of LA and their corresponding index values were significantly higher in group F (p < 0.05 for all). The LA volume before the P wave was also significantly higher in group F than in group C (p < 0.001). The LA active volume and its index were similar between the groups (p = 0.844 and p = 0.842, respectively), whereas the LA passive volume and its index were significantly higher in group F than in group C (p = 0.037 and p = 0.023, respectively). The mean LA ejection fraction was 52.3 ± 7.9% in group F and 57.1 ± 6.4% in group C, indicating a statistically significant difference between the groups (p = 0.001). Lastly, the pulmonary velocity acceleration time (PVAT) and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly higher in group F than in group C (p = 0.023 and p < 0.001, respectively). Discussion Study findings revealed significant differences between the elite football players and healthy non-athlete control subjects in LA morphological and functional parameters. The volumetric and functional echocardiographic parameters of the LA were significantlyhigher intheelite football players.Thismorphological and functional remodelling might be a physiological adaptation mechanism in response to the increased training load. Future prospective studies are needed to corroborate the possible association revealed by the findings of this study between the degree of remodelling and the intensity of physical training. Cardiovascular adaptations can differ depending on the type of physical conditioning, such as endurance or strength training.3,20 However, most disciplines, including football, require a combination of endurance and strength training models. Hence, the variations in training-related physiological adaptations might be attributed to these models. In addition to the acute alterations in the cardiovascular system, the long-term chronic changes also vary according to the type of conditioning.5 Although strength exercises result in nearly stable oxygen uptake, endurance exercises are directly related to the volume and pressure load of the LV.20,21 The enlargement of the heart chambers leading to a larger stroke Table 2. Electrocardiographic findings of the groups. Variables Group F (n = 49) Group C (n = 50) p-value Morphology of P wave, n (%) Biphasic 2 (4.1) 3 (6.0) 0.999*** Positive 47 (95.9) 47 (94.0) Maximum duration of P wave (ms), mean ± SD 112.4 ± 7.4 108.7 ± 6.6 0.011* Minimum duration of P wave (ms), mean ± SD 65.0 ± 6.3 61.3 ± 6.6 0.005* P-wave dispersion time (ms), mean ± SD 47.3 ± 8.1 47.4 ± 8.2 0.935* PR interval (ms), median (min–max) 148.0 (134.0–155.0) 127.5 (124.0–138.0) < 0.001** Interatrial block, n (%) 9 (18.4) 4 (8.0) 0.219*** Anormalpaxy, n (%) 4 (8.2) 3 (6.0) 0.715*** *Independent samples t-test, **Mann–Whitney U-test, ***Pearson’s chi-squared/ Fisher’s exact test. Table 3. Echocardiographic findings of the groups. Variables Group F (n = 49) Group C (n = 50) p-value Structural lnterventricular septum (mm), median (min–max) 10.0 (7.0–12.0) 10.0 (8.0–12.0) 0.543** Posterior wall (mm), median (min–max) 10.0 (7.0–12.0) 10.0 (7.0–12.0) 0.707** LV end-systolic diameter (mm), median (min–max) 32.0 (20.0–46.0) 30.0 (23.0–37.0) 0.011** LV end-diastolic diameter (mm), median (min–max) 50.0 (29.0–56.0) 48.0 (39.0–60.0) 0.004** Aortic root diameter (mm), median (min–max) 30.0 (27.0–36.0) 29.0 (22.0–32.0) 0.012** RV diameter (mm), mean ± SD 28.2 ± 3.9 27.6 ± 3.7 0.401* LV mass (g), mean ± SD 189.8 ± 26.4 178.6 ± 35.9 0.080* LA diameter (mm), mean ± SD 33.0 ± 3.0 29.6 ± 2.8 < 0.001* Volumes and functions of LA Maximum volume (ml), median (min–max) 55.0 (26.0–72.0) 44.0 (21.0–70.0) < 0.001** Minimum volume (ml), median (min–max) 25.0 (14.0–45.0) 19.0 (12.0–35.0) < 0.001** Volume before P wave (ml), median (min–max) 35.0 (18.0–60.0) 27.0 (15.0–48.0) < 0.001** Maximum volume index (ml/m2), mean ± SD 28.4 ± 4.6 23.4 ± 3.8 < 0.001* Minimum volume index (ml/m2), mean ± SD 13.4 ± 2.7 9.9 ± 1.8 < 0.001* Volume index before P wave (ml), median (min–max) 18.1 (9.2–29.0) 14.4 (7.2–21.6) < 0.001** Emptying index, mean ± SD 115.5 ± 36.7 138.1 ± 34.8 0.002* Active emptying volume (ml), mean ± SD 9.1 ± 3.4 8.9 ± 4.4 0.844* Active emptying volume index (ml/m2), mean ± SD 4.7 ± 1.7 4.6 ± 2.2 0.842* Active emptying fraction ratio, mean ± SD 25.9 ± 8.0 30.8 ± 11.0 0.014* Passive emptying volume (ml), mean ± SD 19.6 ± 7.0 17.0 ± 5.1 0.037* Passive emptying volume index (ml/m2), mean ± SD 10.3 ± 3.7 8.8 ± 2.5 0.023* Passive emptying fraction ratio, mean ± SD 35.5 ± 9.4 37.4 ± 8.1 0.291* Ejection fraction (%), mean ± SD 52.3 ± 7.9 57.1 ± 6.4 0.001* Ventricular function LVEF (%), median (min–max) 65.0 (60.0–5.0) 65.0 (54.0–75.0) 0.559** RVEF (%), median (min–max) 65.0 (65.0–5.0) 65.0 (65.0–5.0) – Tissue Doppler Pulmonary acceleration time (ms), mean ± SD 135.7 ± 11.4 130.2 ± 11.9 0.023* Estimated PASP (mmHg), median (min–max) 18.0 (15.0–22.0) 19.0 (15.0–30.0) 0.966** TAPSE (mm), mean ± SD 28.2 ± 3.9 24.2 ± 4.0 < 0.001* LV: left ventricle, RV: right ventricle, LA: left atrium, LVEF: left ventricular ejection fraction, RVEF: right ventricular ejection fraction, PASP: pulmonary artery systolic pressure, TAPSE: tricuspid annular plane systolic excursion. *Independent samples t-test, **Mann–Whitney U-test.
RkJQdWJsaXNoZXIy NDIzNzc=