{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:55:04Z","timestamp":1791359704782,"version":"4.3.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Cardiovasc Imaging"],"DOI":"10.1007\/s10554-025-03503-w","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:39:59Z","timestamp":1756273199000},"page":"1989-1998","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predominant atrial remodeling in elite endurance athletes: a rare and un-investigated type of athlete\u2019s heart?"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-5440","authenticated-orcid":false,"given":"Giuseppe","family":"Di Gioia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosaria","family":"Squeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Ferrera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Monosilio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Mango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Ortolina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Maestrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Raffaele","family":"Spera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pelliccia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"3503_CR1","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1136\/heart.89.12.1455","volume":"89","author":"R Fagard","year":"2003","unstructured":"Fagard R (2003) Athlete\u2019s heart. Heart 89:1455\u20131461. https:\/\/doi.org\/10.1136\/heart.89.12.1455","journal-title":"Heart"},{"key":"3503_CR2","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd10070269","volume":"10","author":"C Johnson","year":"2023","unstructured":"Johnson C, Sculthorpe N, George K et al (2023) Concentric and eccentric remodelling of the left ventricle and its association to function in the male athletes heart: an exploratory study. J Cardiovasc Dev Dis 10:269. https:\/\/doi.org\/10.3390\/jcdd10070269","journal-title":"J Cardiovasc Dev Dis"},{"key":"3503_CR3","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1161\/01.cir.101.3.336","volume":"101","author":"BM Pluim","year":"2000","unstructured":"Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE (2000) The athlete\u2019s heart. A meta-analysis of cardiac structure and function. Circulation 101:336\u2013344. https:\/\/doi.org\/10.1161\/01.cir.101.3.336","journal-title":"Circulation"},{"key":"3503_CR4","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/s0733-8651(05)70348-9","volume":"15","author":"RH Fagard","year":"1997","unstructured":"Fagard RH (1997) Impact of different sports and training on cardiac structure and function. Cardiol Clin 15:397\u2013412. https:\/\/doi.org\/10.1016\/s0733-8651(05)70348-9","journal-title":"Cardiol Clin"},{"key":"3503_CR5","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1152\/japplphysiol.01170.2007","volume":"104","author":"AL Baggish","year":"2008","unstructured":"Baggish AL, Wang F, Weiner RB et al (2008) Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes. J Appl Physiol (1985) 104:1121\u20131128. https:\/\/doi.org\/10.1152\/japplphysiol.01170.2007","journal-title":"J Appl Physiol (1985)"},{"key":"3503_CR6","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1093\/eurjpc\/zwac026","volume":"29","author":"A F\u00e1bi\u00e1n","year":"2022","unstructured":"F\u00e1bi\u00e1n A, Ujv\u00e1ri A, Tokodi M et al (2022) Biventricular mechanical pattern of the athlete\u2019s heart: comprehensive characterization using three-dimensional echocardiography. Eur J Prev Cardiol 29:1594\u20131604. https:\/\/doi.org\/10.1093\/eurjpc\/zwac026","journal-title":"Eur J Prev Cardiol"},{"key":"3503_CR7","doi-asserted-by":"publisher","first-page":"467","DOI":"10.4065\/76.5.467","volume":"76","author":"TS Tsang","year":"2001","unstructured":"Tsang TS, Barnes ME, Bailey KR et al (2001) Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc 76:467\u2013475. https:\/\/doi.org\/10.4065\/76.5.467","journal-title":"Mayo Clin Proc"},{"key":"3503_CR8","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1161\/01.cir.89.2.724","volume":"89","author":"SM Vaziri","year":"1994","unstructured":"Vaziri SM, Larson MG, Benjamin EJ, Levy D (1994) Echocardiographic predictors of nonrheumatic atrial fibrillation. Framingham Heart Study Circulation 89:724\u2013730. https:\/\/doi.org\/10.1161\/01.cir.89.2.724","journal-title":"Framingham Heart Study Circulation"},{"key":"3503_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s44325-024-00032-8","volume":"1","author":"LW Spencer","year":"2024","unstructured":"Spencer LW, D\u2019Ambrosio P, Ohanian M et al (2024) Atrial cardiomyopathy in endurance athletes. NPJ Cardiovasc Health 1:1\u20139. https:\/\/doi.org\/10.1038\/s44325-024-00032-8","journal-title":"NPJ Cardiovasc Health"},{"key":"3503_CR10","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.echo.2017.11.009","volume":"31","author":"F D\u2019Ascenzi","year":"2018","unstructured":"D\u2019Ascenzi F, Anselmi F, Focardi M, Mondillo S (2018) Atrial enlargement in the athlete\u2019s heart: assessment of atrial function May help distinguish adaptive from pathologic remodeling. J Am Soc Echocardiogr 31:148\u2013157. https:\/\/doi.org\/10.1016\/j.echo.2017.11.009","journal-title":"J Am Soc Echocardiogr"},{"key":"3503_CR11","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","volume":"42","author":"A Pelliccia","year":"2021","unstructured":"Pelliccia A, Sharma S, Gati S et al (2021) 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease: the task force on sports cardiology and exercise in patients with cardiovascular disease of the European society of cardiology (ESC). Eur Heart J 42:17\u201396. https:\/\/doi.org\/10.1093\/eurheartj\/ehaa605","journal-title":"Eur Heart J"},{"key":"3503_CR12","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1056\/NEJM198710223171717","volume":"317","author":"RD Mosteller","year":"1987","unstructured":"Mosteller RD (1987) Simplified calculation of body-surface area. N Engl J Med 317:1098. https:\/\/doi.org\/10.1056\/NEJM198710223171717","journal-title":"N Engl J Med"},{"key":"3503_CR13","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1136\/bjsports-2016-097331","volume":"51","author":"JA Drezner","year":"2017","unstructured":"Drezner JA, Sharma S, Baggish A et al (2017) International criteria for electrocardiographic interpretation in athletes: consensus statement. Br J Sports Med 51:704\u2013731. https:\/\/doi.org\/10.1136\/bjsports-2016-097331","journal-title":"Br J Sports Med"},{"issue":"38","key":"3503_CR14","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae178","volume":"45","author":"JW McEvoy","year":"2024","unstructured":"McEvoy JW, McCarthy CP, Bruno RM et al (2024) 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur Heart J ehae178. https:\/\/doi.org\/10.1093\/eurheartj\/ehae178","journal-title":"Eur Heart J"},{"key":"3503_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","volume":"28","author":"RM Lang","year":"2015","unstructured":"Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 28:1\u201339e14. https:\/\/doi.org\/10.1016\/j.echo.2014.10.003","journal-title":"J Am Soc Echocardiogr"},{"key":"3503_CR16","doi-asserted-by":"publisher","first-page":"II19","DOI":"10.1161\/01.hyp.9.2_pt_2.ii19","volume":"9","author":"RB Devereux","year":"1987","unstructured":"Devereux RB (1987) Detection of left ventricular hypertrophy by M-mode echocardiography. Anatomic validation, standardization, and comparison to other methods. Hypertension 9:II19\u201326. https:\/\/doi.org\/10.1161\/01.hyp.9.2_pt_2.ii19","journal-title":"Hypertension"},{"key":"3503_CR17","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1093\/ejechocard\/jer021","volume":"12","author":"V Mor-Avi","year":"2011","unstructured":"Mor-Avi V, Lang RM, Badano LP et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE\/EAE consensus statement on methodology and indications endorsed by the Japanese society of echocardiography. Eur J Echocardiogr 12:167\u2013205. https:\/\/doi.org\/10.1093\/ejechocard\/jer021","journal-title":"Eur J Echocardiogr"},{"key":"3503_CR18","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.1093\/eurheartj\/ehx532","volume":"39","author":"A Pelliccia","year":"2018","unstructured":"Pelliccia A, Caselli S, Sharma S et al (2018) European association of preventive cardiology (EAPC) and European association of cardiovascular imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete\u2019s heart. Eur Heart J 39:1949\u20131969. https:\/\/doi.org\/10.1093\/eurheartj\/ehx532","journal-title":"Eur Heart J"},{"key":"3503_CR19","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11886-014-0561-9","volume":"17","author":"D Maragiannis","year":"2015","unstructured":"Maragiannis D, Nagueh SF (2015) Echocardiographic evaluation of left ventricular diastolic function: an update. Curr Cardiol Rep 17:3. https:\/\/doi.org\/10.1007\/s11886-014-0561-9","journal-title":"Curr Cardiol Rep"},{"key":"3503_CR20","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","volume":"29","author":"SF Nagueh","year":"2016","unstructured":"Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 29:277\u2013314. https:\/\/doi.org\/10.1016\/j.echo.2016.01.011","journal-title":"J Am Soc Echocardiogr"},{"key":"3503_CR21","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","volume":"23","author":"LG Rudski","year":"2010","unstructured":"Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American society of echocardiography: endorsed by the European association of echocardiography, a registered branch of the European society of cardiology, and the Canadian society of echocardiography. J Am Soc Echocardiogr 23:685\u2013713. https:\/\/doi.org\/10.1016\/j.echo.2010.05.010","journal-title":"J Am Soc Echocardiogr"},{"key":"3503_CR22","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s13054-019-2413-x","volume":"23","author":"M Jozwiak","year":"2019","unstructured":"Jozwiak M, Mercado P, Teboul J-L et al (2019) What is the lowest change in cardiac output that transthoracic echocardiography can detect? Crit Care 23:116. https:\/\/doi.org\/10.1186\/s13054-019-2413-x","journal-title":"Crit Care"},{"key":"3503_CR23","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","volume":"16","author":"RM Lang","year":"2015","unstructured":"Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. European Heart Journal \u2013 Cardiovascular Imaging 16:233\u2013271. https:\/\/doi.org\/10.1093\/ehjci\/jev014","journal-title":"European Heart Journal \u2013 Cardiovascular Imaging"},{"key":"3503_CR24","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1093\/ehjci\/jet184","volume":"14","author":"JD Thomas","year":"2013","unstructured":"Thomas JD, Badano LP (2013) EACVI-ASE-industry initiative to standardize deformation imaging: a brief update from the co-chairs. Eur Heart J Cardiovasc Imaging 14:1039\u20131040. https:\/\/doi.org\/10.1093\/ehjci\/jet184","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"1","key":"3503_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ehjci\/jeu184","volume":"16","author":"J-U Voigt","year":"2015","unstructured":"Voigt J-U, Pedrizzetti G, Lysyansky P et al (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI\/ASE\/industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 16(1):1\u201311. https:\/\/doi.org\/10.1093\/ehjci\/jeu184","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"3503_CR26","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1016\/j.echo.2019.02.014","volume":"32","author":"NFA Edwards","year":"2019","unstructured":"Edwards NFA, Scalia GM, Shiino K et al (2019) Global myocardial work is superior to global longitudinal strain to predict significant coronary artery disease in patients with normal left ventricular function and wall motion. J Am Soc Echocardiogr 32:947\u2013957. https:\/\/doi.org\/10.1016\/j.echo.2019.02.014","journal-title":"J Am Soc Echocardiogr"},{"key":"3503_CR27","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1093\/ehjci\/jey042","volume":"19","author":"LP Badano","year":"2018","unstructured":"Badano LP, Kolias TJ, Muraru D et al (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI\/ASE\/Industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 19:591\u2013600. https:\/\/doi.org\/10.1093\/ehjci\/jey042","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"3503_CR28","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1111\/echo.12834","volume":"32","author":"S Hayashi","year":"2015","unstructured":"Hayashi S, Yamada H, Bando M et al (2015) Optimal analysis of left atrial strain by speckle tracking echocardiography: P-wave versus R-wave trigger. Echocardiography 32:1241\u20131249. https:\/\/doi.org\/10.1111\/echo.12834","journal-title":"Echocardiography"},{"key":"3503_CR29","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1093\/eurjhf\/hft087","volume":"15","author":"S-H Hsiao","year":"2013","unstructured":"Hsiao S-H, Chiou K-R (2013) Left atrial expansion index predicts all-cause mortality and heart failure admissions in dyspnoea. Eur J Heart Fail 15:1245\u20131252. https:\/\/doi.org\/10.1093\/eurjhf\/hft087","journal-title":"Eur J Heart Fail"},{"key":"3503_CR30","doi-asserted-by":"publisher","first-page":"2725","DOI":"10.1007\/s00421-024-05489-0","volume":"124","author":"G Di Gioia","year":"2024","unstructured":"Di Gioia G, Crispino SP, Maestrini V et al (2024) Lack of cardiac remodelling in elite endurance athletes: an unexpected and not so rare finding. Eur J Appl Physiol 124:2725\u20132735. https:\/\/doi.org\/10.1007\/s00421-024-05489-0","journal-title":"Eur J Appl Physiol"},{"key":"3503_CR31","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1161\/CIRCULATIONAHA.106.613562","volume":"114","author":"BJ Maron","year":"2006","unstructured":"Maron BJ, Pelliccia A (2006) The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 114:1633\u20131644. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.106.613562","journal-title":"Circulation"},{"key":"3503_CR32","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/0002-8703(85)90247-9","volume":"109","author":"AM Hauser","year":"1985","unstructured":"Hauser AM, Dressendorfer RH, Vos M et al (1985) Symmetric cardiac enlargement in highly trained endurance athletes: a two-dimensional echocardiographic study. Am Heart J 109:1038\u20131044. https:\/\/doi.org\/10.1016\/0002-8703(85)90247-9","journal-title":"Am Heart J"},{"key":"3503_CR33","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.ahj.2020.05.015","volume":"226","author":"DC Peritz","year":"2020","unstructured":"Peritz DC, Catino AB, Csecs I et al (2020) High-intensity endurance training is associated with left atrial fibrosis. Am Heart J 226:206\u2013213. https:\/\/doi.org\/10.1016\/j.ahj.2020.05.015","journal-title":"Am Heart J"},{"issue":"4","key":"3503_CR34","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1016\/j.jacc.2005.04.052","volume":"46","author":"A Pelliccia","year":"2005","unstructured":"Pelliccia A, Maron BJ, Di Paolo FM et al (2005) Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol 46(4):690\u2013696. https:\/\/doi.org\/10.1016\/j.jacc.2005.04.052","journal-title":"J Am Coll Cardiol"},{"key":"3503_CR35","doi-asserted-by":"publisher","first-page":"731","DOI":"10.2459\/JCM.0000000000001657","volume":"25","author":"G Di Gioia","year":"2024","unstructured":"Di Gioia G, Vespasiano F, Maestrini V et al (2024) Determinants of supraventricular extra beats in elite athletes practicing different sporting disciplines. J Cardiovasc Med (Hagerstown) 25:731\u2013739. https:\/\/doi.org\/10.2459\/JCM.0000000000001657","journal-title":"J Cardiovasc Med (Hagerstown)"}],"container-title":["The International Journal of Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-025-03503-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10554-025-03503-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-025-03503-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T05:16:09Z","timestamp":1759382169000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10554-025-03503-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,27]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["3503"],"URL":"https:\/\/doi.org\/10.1007\/s10554-025-03503-w","relation":{},"ISSN":["1875-8312"],"issn-type":[{"value":"1875-8312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,27]]},"assertion":[{"value":"30 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None. The authors declare to have no financial interests or affiliations with institutions, organizations or companies mentioned in the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Conflicts of interest"}},{"value":"The study design of the present investigation was evaluated and approved by the Review Board of the Institute of Sports Medicine and Science (ISMS), Italian National Olympic Committee and from the ethic committee of Sapienza University of Roma, date of approval: 25.09.2024, code 0851\/2024. All athletes included in this study were fully informed of the types and nature of the evaluation and signed the consent form, pursuant to Italian Law and ISMS policy. All clinical data assembled from the study population are maintained in an institutional database.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"De-identified participant data are available upon reasonable request from the corresponding author.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data sharing"}}]}}