Left Atrium Size in Elite Athletes

Study Questions:

What is the relationship between high levels of exercise training and left atrial (LA) size?


A systematic review of English-language literature in Medline and Scopus from inception through April 2014 was used to identify studies that reported LA size in elite athletes. A meta-analysis was performed using studies reporting on athletes 18-40 years of age competing at international or national levels, and evaluated echocardiographic LA absolute diameter or LA volume indexed to body surface area.


A total of 54 studies comprising 7,189 elite athletes and 1,375 controls were included. Of 54 studies, 48 reported absolute LA diameter in 7,018 athletes and 1,044 controls; 9 of 54 studies (including 992 athletes and 426 controls) reported LA volume corrected for body surface area. The adjusted weighted mean LA diameter was 4.1 mm greater in athletes overall compared with sedentary controls (p < 0.0001), and LA volume index was 7.0 ml/m2 greater in athletes than controls (p < 0.01). Compared with controls, LA diameter was 4.6 mm greater in endurance-trained athletes (p < 0.0001), 2.9 mm greater in strength-trained athletes (p < 0.03), 3.5 mm greater in combined strength- and endurance-trained athletes (p < 0.0001), and 4.2 mm greater in athletes with unspecified training (p < 0.02).


Compared to controls, elite athletes have larger LA dimensions when evaluated by either LA diameter or LA volume corrected for body surface area. The largest average LA diameters were reported in endurance athletes. The authors concluded that physicians evaluating athletes should be aware that the LA is increased in both strength- and endurance-trained elite athletes.


Substantial literature exists regarding adaptive cardiac changes associated with athletic conditioning. This meta-analysis provides data supporting existing observations that LA enlargement is common among both endurance- and strength-trained athletes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Echocardiography/Ultrasound, Exercise, Sports and Exercise and Imaging

Keywords: Athletes, Body Surface Area, Diagnostic Imaging, Echocardiography, Exercise, Heart Atria, Physical Endurance, Resistance Training, Sports

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