Incidence of Atrial Fibrillation in Elite Athletes.

Importance: Vigorous exercise (particularly endurance sports) might increase the risk of atrial fibrillation (AF), but there is variability in the reported frequency of this condition among elite athletes. The underlying pathophysiologic source remains unclear. Objective: To determine AF incidence in a large cohort of elite athletes and its association with potential risk factors. Design, Setting, and Participants: Retrospective observational cohort of all Spanish athletes (N = 6813) referred to a single center was used to determine AF incidence from January 1, 1997, to December 31, 2017, and cross-sectional analysis was conducted to compare athletes with and without reported AF. The cohort covered most sports disciplines, and the studied athletes were on national teams and competed in major international events. Cardiologists responsible for echocardiographic assessment were not blinded to the condition (AF or no AF) of the athletes. Exposures: All participants underwent at least 1 cardiologic evaluation, including assessment at time of AF diagnosis in those with this condition. Main Outcomes and Measures: Diagnosis of AF based on resting and/or exercise electrocardiogram, and/or 24-hour Holter monitoring and echocardiography-assessed atrial dimensions. Results: A total of 6813 Spanish elite athletes (2385 [35.0%] women) were referred for cardiac evaluation during the study period. Mean (SD) age was 22 (7) years, and mean (SD) time of competition was 8 (5) years. Only 21 athletes (1 woman), participating in different types of sports, had AF (ie, paroxysmal [n = 18], persistent [n = 1], or long-standing persistent [n = 2]) during the 20-year study. In multivariate analysis, increasing values of age (odds ratio [OR], 1.07; 95% CI, 1.00-1.14), years of competition (OR, 1.14; 95% CI, 1.07-1.22), and left atrial anteroposterior diameter (OR, 1.21; 95% CI, 1.10-1.32) were associated with higher AF risk. Conclusions and Relevance: The incidence of AF is low among young Spanish elite athletes, even when considering only endurance athletes. Yet, potential contributors (particularly atrial remodeling) need to be monitored.

Cardiovascular adaptation, functional capacity and Angiotensin-converting enzyme I/D polymorphism in elite athletes.

INTRODUCTION AND OBJECTIVES: Angiotensin-converting enzyme (ACE) is associated with the development of cardiac hypertrophy and improved physical fitness. The objective of this study was to investigate the relationship between the ACE gene insertion/deletion (I/D) polymorphism and adaptation to sports training. METHODS: The study included 299 elite Spanish athletes (193 men and 106 women) from 32 different sports disciplines, which were grouped according to their static and dynamic components. All participants underwent body composition analysis, Doppler echocardiography at rest, and ergospirometry. Their ACE genotype was determined using the polymerase chain reaction. RESULTS: The most common genotype in both males and females was the deletion-insertion (DI) heterozygote (57.5% and 54.7%, respectively), followed by the DD homozygote (30.6% and 34.9%), and the II homozygote (11.9% and 10.4%). Differences in morphometric and functional cardiac adaptation were observed between the different sports disciplines, but there was no statistically significant relationship with the ACE I/D polymorphism. Moreover, when athletes with different genotypes were compared, the only differences observed were between the DD and DI groups in female athletes, who differed in body mass index and longitudinal right atrial dimension. CONCLUSIONS: The ACE I/D polymorphism did not appear to influence cardiovascular adaptation in response to training. However, the DI genotype was the most common, probably because the sample was biased by being made up of elite athletes.

Adaptación cardiovascular, capacidad funcional y polimorfismo inserción/deleción de la enzima de conversión de angiotensina en deportistas de élite / Cardiovascular adaptation, functional capacity and angiotensin-converting enzyme I/D polymorphism in elite athletes

Introducción y objetivos. La enzima de conversión de angiotensina (ECA) se relaciona con el desarrollo de hipertrofia cardiaca y mejora de la condición física. El objetivo del estudio es analizar la relación entre el polimorfismo inserción/deleción (I/D) del gen de la ECA y la adaptación al entrenamiento. Métodos. Se estudió a 299 deportistas españoles de alto nivel (193 varones y 106 mujeres) de 32 disciplinas deportivas, agrupadas según sus componentes estático y dinámico, mediante análisis de la composición corporal, eco-Doppler en reposo y ergoespirometría. El genotipo de la ECA se determinó mediante la técnica de la reacción en cadena de la polimerasa (PCR). Resultados. El genotipo más frecuente fue el heterocigoto DI (el 57,5 y el 54,7%), seguido de los homocigotos DD (el 30,6 y el 34,9%) e II (el 11,9 y el 10,4%), en varones y mujeres respectivamente. Hay diferencias en las adaptaciones morfológicas y funcionales entre las modalidades deportivas, pero no se obtuvo asociación estadísticamente significativa con relación al polimorfismo I/D de la ECA. En el estudio comparativo entre los distintos genotipos, sólo en la muestra femenina se encontraron diferencias entre los grupos DD y DI en el índice de masa corporal y en la dimensión superoinferior de la aurícula derecha. Conclusiones. El polimorfismo I/D del gen de la ECA parece que no influye en la adaptación cardiovascular al entrenamiento; sin embargo, el genotipo DI es el más frecuente, probablemente debido a un sesgo de la muestra, compuesta por deportistas de élite (AU)

Introduction and objectives. Angiotensin-converting enzyme (ACE) is associated with the development of cardiac hypertrophy and improved physical fitness. The objective of this study was to investigate the relationship between the ACE gene insertion/deletion (I/D) polymorphism and adaptation to sports training. Methods. The study included 299 elite Spanish athletes (193 men and 106 women) from 32 different sports disciplines, which were grouped according to their static and dynamic components. All participants underwent body composition analysis, Doppler echocardiography at rest, and ergospirometry. Their ACE genotype was determined using the polymerase chain reaction. Results. The most common genotype in both males and females was the deletion-insertion (DI) heterozygote (57.5% and 54.7%, respectively), followed by the DD homozygote (30.6% and 34.9%), and the II homozygote (11.9% and 10.4%). Differences in morphometric and functional cardiac adaptation were observed between the different sports disciplines, but there was no statistically significant relationship with the ACE I/D polymorphism. Moreover, when athletes with different genotypes were compared, the only differences observed were between the DD and DI groups in female athletes, who differed in body mass index and longitudinal right atrial dimension. Conclusions. The ACE I/D polymorphism did not appear to influence cardiovascular adaptation in response to training. However, the DI genotype was the most common, probably because the sample was biased by being made up of elite athletes (AU)