Brazilian Journal of Biomotricity ISSN: Universidade Iguaçu Brasil

Transcription

1 Brazilian Journal of Biomotricity ISSN: Universidade Iguaçu Brasil Kaur, Kulroop EFFECT OF STRENGTH TRAINING ON LEFT ATRIUM IN WRESTLERS Brazilian Journal of Biomotricity, vol. 7, núm. 3, septiembre-, 2013, pp Universidade Iguaçu Itaperuna, Brasil Available in: How to cite Complete issue More information about this article Journal's homepage in redalyc.org Scientific Information System Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Non-profit academic project, developed under the open access initiative

2 ORIGINAL PAPER (ARTIGO ORIGINAL) EFFECT OF STRENGTH TRAINING ON LEFT ATRIUM IN WRESTLERS Dr. Kulroop Kaur 1 1- Research Scholar, MBBS, Baba Farid University of Health Sciences, Faridkot, Punjab, INDIA. Corresponding author: Dr. Kulroop Kaur Badwal, M.B.B.S. Research Scholar Baba Farid University of Health Sciences, Faridkot, Punjab, INDIA Contact: doctoralifesaver1@gmail.com Submitted for publication: Jun 2012 Accepted for publication: Jan 2013 ABSTRACT Kaur, K. effect of strength training on left atrium in wrestlers. Brazilian Journal of Biomotricity. v. 7, n. 3, p , The aim of this study was to determine the consequences of atrial remodelling and clinical significance of left atrial size in context of athlete s heart and its proclivity to produce supra-ventricular tachyarrhythmia. We assessed left atrial dimension in 60 subjects; divided equally in two groups, wrestlers (n=30) and sedentary group (n=30). All subjects were male and free of any structural cardiovascular disease. The left atrial dimension was 2.8 to 3.9 cm (mean, 3.3± 0.28) in wrestlers group and 2.1 to 3.0 (mean, 2.8± 0.5) in the control group. No wrestler had documented symptomatic episodes of paroxysmal atrial fibrillation or supra-ventricular tachyarrhythmia. Stepwise regression analysis showed left atrial enlargement in wrestlers was largely explained by enlarged left ventricular cavity dimensions (R2 = 0.52). In the wrestlers group, the enlarged left atrial and ventricular dimension was found as compared to sedentary counterparts. Atrial fibrillation and supraventricular tachyarrhythmias were not reported. Thus signifying that left atrial remodelling in wrestlers to be regarded as a physiological adaptation to the chronic strength training protocol, without adverse clinical consequences and not pathological. Keywords: Left atrium remodelling, wrestlers, echocardiography. INTRODUCTION Left atrial (LA) enlargement is an important predictor of cardiovascular events such as atrial fibrillation, stroke, heart failure and mortality and it has been found to be an independent predictor of atrial fibrillation (AF) in normal population and in patients suffering from hypertrophic cardiomyopathy (OLIVOTTO I. ET AL. 2001; GAVAZZI A. ET AL. 1993). The LA is structurally and functionally linked to the left ventricular (LV) function. Structurally, the LA typically undergoes dilatation on prolonged exposure to increased hemodynamic load, e.g. exercise. Functionally, LA has been described as a reservoir during LV systole, a conduit during early diastole and actively contract during late diastole to aid the ventricular filling. Hence LA is estimated to contribute % of the LV filling volume during the active phase (CHEE. ET AL. 2011). Previous investigations have suggested that even the athletes are predisposed to atrial fibrillation (KOPECKY. ET AL. 1987; TSANG. ET AL. 2001). The possible reason for the existence of the condition in athletes 139

3 might be the cardiac remodelling associated with long term exercise protocols (COUMEL. ET AL. 2002; ORGANROTH. ET AL. 1975). An increased wall tension giving rise to increased filling pressure has been found to be common cause of the atrial size enlargement. LA enlargement is a marker of both severity and chronicity of diastolic dysfunction and magnitude of LA pressure elevation. So it becomes important to have upper limit defining for athletes as well in which the atrial remodelling is seen. One study has demonstrated the effect of atrial remodelling in endurance trained group concluding that highly trained athletes have enlarged left atrium due to atrial remodelling, and is a physiologic adaptation to exercise conditioning (ANTONIO. ET AL. 2005). However no study has been done on wrestlers to know the effect of atrial remodelling in this strength trained group. The echocardiography patterns in professional wrestlers have revealed that left ventricular dimensions are significantly higher in wrestlers than the normal population, probably due to the regular strength training and physical activity involved (SOBHANI. ET AL. 2010). But the effect on left atrium was not studied. Previous studies have also shown the association between increased antero-posterior dimension by M-Mode measurement and the development of AF. In the Framingham Heart Study a 5 mm incremental increase in the antero-posterior LA diameter on M- Mode was associated a 39% increased risk for developing AF. Similarly, the cardiovascular health study reported a fourfold increase in the risk of developing AF in patients with an antero-posterior diameter LA of >5mm (CHEE. ET AL. 2011). In the present study involving wrestlers of national and international competitive level and a group of age matched controls were taken to study the left atrial size and it s remodelling with context to other features of Athlete s Heart in the absence of any other structural heart disease. MATERIAL E METHODS Sample The researcher utilized the experimental method on a sample of 30 male wrestlers along with 30 male sedentary but otherwise healthy controls. All athletes had been under strength training for approximately minimum of 3 years. They had been active in the training sessions and the readings were taken in the peak season. The training sessions of 4 hrs/ day and 6 days/week were regularly done by the wrestlers. The research was approved by Research Ethics Committee. The subjects under study aged from 18 to 24 years (21.18± 1.535) and weighed between 50 and 122 kilograms (69.87± 13.22). The anthropometric data of both the groups is presented in Table 1. Table 1. Anthropometric data of wrestlers and control group, Quantities represented are mean ± standard deviation and the p value obtained after independent samples test. Variant Wrestlers Control p-value Age 20.73± ± Height ± ±9.417 <.001 Weight 74.43± ± Body Surface area (BSA) 1.86± ±0.13 <.001 Echocardiography Two-dimensional and M-mode echocardiography was performed on all the subjects in the morning after their regular conditioning workout (using Philips ie 33, X-matrix, USA). Measurements of left ventricular end-diastolic dimension were taken through M-mode echocardiography. Left atrium (LA) measurements were also taken in M-mode for calculating the maximum Antero-posterior diameter. The LA was measured at the end of ventricular systole when it has the maximum dimension. The focus of the study was to see the extent of enlargement of LA in wrestlers as compared to control group. Left ventricular mass (LVM) was calculated by the echocardiography machine in the parasternal short axis view. The arbitrary cut-off value of >4.0 cm was chosen to estimate enlarged LA transverse dimension as this value is widely used for defining LA enlargement in general practice (FEIGENBAUM. ET AL. 1986). 140

4 STATISTICAL ANALYSIS All data are expressed as mean± standard deviation. Differences between means were assessed by independent samples t-test. A two tailed p <0.05 was considered statistically significant. Stepwise regression analysis was used afterwards to assess the impact of various variables (left ventricular dimensions, left ventricular mass, training level) on the left atrium dimensions. RESULTS No pathological and structural defects in the myocardium were evident during the echocardiography examination in any of the subjects. The analysis of the data revealed that most of the echocardiography LV parameters were significantly affected in the wrestlers group. Table 2. Cardiographic parameters of the subjects represented by mean ± standard deviation and p-value. Variant Wrestlers Control p-value Left Atrium 3.38± ±0.51 <.001 LVED 5.15± ±0.55 <.001 LVM ± ± HR 63.20± ±0.552 <.001 The stepwise- regression analysis indicated that the LVED dimension was associated with LA dimension, and no other was found to be significantly effect on the left atrium. In both the groups, the LA ranged from 4.4 to 3.2 cm (3.1198± 4.90) and the enlarged atrium was found in just one subject. The arbitrary value taken and the difference found are subject to genetic, race and anthropometric differences in the study group FEIGENBAUM. ET AL The existing literature hints that there are racial and ethnic differences in the epidemiology of AF. DISCUSSION Left atrial enlargement in context to the physiological features of athlete s heart has been found to be responsible for atrial fibrillation in highly trained athletes especially when associated with sinus bradycardia (FURLANELLO. ET AL. 1998; JENSEN-URSTAD. 1998). As Table 2 depicts, the left atrial dimensions were found significantly higher in the wrestlers group (p <0.001). It shows that though the left atrium is enlarged in wrestlers as compared to the sedentary age matched control group, but it still falls under the arbitrary value of 4.0 cm. The highest value in wrestlers group was found to be 3.9 cm and no other cardiac deformity was revealed during the tests in those wrestlers. Thus the clinically abnormalities arise when the dimensions are more than 4.5 cm as reported in the previous studies (SOBHANI. ET AL. 2010) which also showed that in the group having dimensions <4.0cm and between cm are less prone to atrial dysfunction as compared to the group having >4.5 cm dimension. The LVED dimensions were found to be significantly higher in the wrestlers group thus supporting the results postulated from previous studies (FEIGENBAUM. ET AL. 1986). Thus supporting the statement that regular strength training induces cardiac hypertrophy. In our study the mean of left ventricular mass was not found to be higher in the wrestlers as stated by (SOBHANI. ET AL. 2010). Furthermore, the regression analysis has showed that LVED has a greater impact on the enlargement of left atrium than any other factor (R2 = 0.52). Thus, postulating that >50% of variability in the atrial cavity size is caused by LVED. By regression analysis, we calculated that each increase of 1 mm in LVED dimension was associated with a

5 mm increase in the left atrial dimension. The present data shows that LA remodelling associated with intense exercise and long term strength training and conditioning does not predispose to atrial fibrillations or supra-ventricular tachyarrhythmia if the dimensions are within or near normal limits. It also provides an assessment of LA dimension with the purpose of defining the upper limits of enlarged atrium in athletes associated with strength training; whose recognition is of particular clinical importance to give relevance to distinguish between physiological and benign atrial remodelling in wrestlers from structural heart diseases. ACKNOWLEDGEMENTS I would like to ac knowledge the athletes for all their as sistance in data collection for this project. RECOMMENDATION Similar study should be carried on large number of athletes of various sports disciplines so that an arbitrary value for left atrial enlargement can be set for the Asian athletes. REFERENCES ANTONIO PELLICCIA.; BARRY J.; MARON, FERNANDO M.; DI PAOLO, ALESSANDRO BIFFI, FILIPPO M.; QUATTRINI, CATALDO PISICCHIO.; ALESSANDRA ROSELLI.; STEFANO CASELLI.; FRANCO CULASSO. Left atrial remodelling in competitive athletes. Am J Cardiol. v.46, p.690-6, BENJAMIN E.J.; D AGOSTINO R.B.; BELANGER A.J.; WOLF P.A.; LEVY D. Left atrial size and the risk of stroke and death: the Framingham Heart Study. Circulation. v.92, p , CHEE W.K.; SURESH KRISHNAMOORTHY.; HOONG SERN LIM.; GREGORY Y.H. Assessment of left atrial volume: a focus on echocardiography methods and clinical implications. Clin Res Cardiol. v.100, p , CHUKWUEMEKA A.C.; AL-HAZZAA H.M. Echocardiography studies in Saudi Athletes. Saudi Heart Asso J. v.22, p , COUMEL P. Atrial fibrillation: one more sporting inconvenience. Eur Heart J. v.23, p.431-3, COUMEL P. Autonomic influences in atrial tachyarrhythmia. J Cardiovasc Electrophysiol. v.7, p , ESTES N.A.; LINK M.S.; CANNOM D. Report of the NASPE policy conference on arrhythmias and the athlete. J Cardiovasc Electrophysiol. v.12, p , FEIGENBAUM H. Echocardiography. 4th edition. Philadelphia, PA: Lea & Febiger; p.622, FURLANELLO F., BERTOLDI A., DALLAGO M. Atrial fibrillation in elite athletes. J Cardiovasc Electrophysiol. v.9, p.63-8, GAVAZZI A.; MARIA R.; RENOSTO G. The spectrum of left ventricular size in dilated cardiomyopathy: clinical correlates and prognostic implications. SPIC (Italian Multicenter Cardiomyopathy Study Group). Am Heart J. v.125, p , HOOGSTEEN J.; SCHEP G.; VAN HEMEL N.M.; VAN DER WALL E.E. Paroxysmal atrial fibrillation in male endurance athletes. A 9-year follow up. Europace. v.6, p.222-8,

6 JENSEN-URSTAD K. High prevalence of arrhythmias in elderly male athletes with a lifelong history of regular strenuous exercise. Heart. v.79, p.161 4, KOPECKY S.L.; GERSH B.J.; MCGOON M.D, The natural history of lone atrial fibrillation: a population-based study over three decades. N Engl J Med. v.317, p , LINK M.S.; WANG P.J.; ESTES N.A. Cardiac arrhythmias and electrophysiologic observations in the athlete. In: Williams R, editor. The Athlete and Heart Disease. Philadelphia, PA: Lippincott Williams & Wilkins, p , MONT L.; SAMBOLA A.; BRUGADA J. Long-lasting sport practice and lone atrial fibrillation. Eur Heart J. v.23, p , MORGANROTH J.; MARON B.J.; HENRY W.L.; EPSTEIN S.E. Comparative left ventricular dimensions in trained athletes. Ann Intern Med, v.82, p.521-4, OLIVOTTO I.; CECCHI F.; CASEY S.A.; DOLORA A.; TRAVERSE J.H.; MARON B.J. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation. v.104, p , PELLICCIA A.; MARON B.J.; CULASSO F. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. v.102, p , SOBHANI, V.S.; VAHEDI, B.; FARAHANI, E.; ALI BAKSHI. Echocardiographic findings in professional wrestlers. Iranian cardio research J. v.4, p.123-6, TOUTOUZAS K.; TRIKAS A.; PITSAVOS C. Echocardiography features of left atrium in elite male athletes. Am J Cardiol. v.78, p , TSANG T.S.; BARNES M.E.; BAILEY K.R. Left atrial volume: important risk marker of incident atrial fibrillation in 1,655 older men and women. Mayo Clinic Proc. v.76, p , VAZIRI S.M.; LARSON M.G.; BENJAMIN E.J.; LEVY D. Echocardiographic predictors of nonrheumatic atrial fibrillation: the Framingham Heart Study. Circulation. v.89, p , VENCKUNAS T, LIONIKAS A, JOLANTA E. MARCINKEVICIENE, RAUGALIENE R, ALEKRINSKIS A AND STASIULIS A. Echocardiography parameters in athletes of different sports. J of sports science and Medicine. v.7, p ,