{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:19:38Z","timestamp":1781860778739,"version":"3.54.5"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Left atrial (LA) size and function are linked to exercise intolerance in heart failure, while associations between LA parameters and exercise performance remain unclear in athletes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aimed to identify correlations between echocardiographic LA size, pressure, stiffness, and composite indices, and various exercise performance indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Echocardiographic parameters were obtained from 181 physically active military personnel receiving regular training and tests for a 3-km run and 2\u2005min of push-ups and sit-ups. The top 16% of runners were compared sex-specifically, with the remaining 84% as controls to identify LA discriminators for running capacity. LA composite indices were defined as the LA volume index (LAVI) divided by the stiffness index (LASI) or pressure index (mitral E\/e\u2032). Spearman correlations were used to identify LA correlates with exercise performance. Generalized linear regressions were used to identify LA predictors of exercise performance with adjustments for potential covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The top 16% of runners vs. controls had a lower LASI based on LA volume changes (LASI_v, 0.196 vs. 0.245, <jats:italic>p<\/jats:italic>\u2009=\u20090.013) and higher LAVI-to-LASI_v (12.30 vs. 8.08, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and LAVI-to-(mitral E\/e\u2032) (4.37 vs. 3.76, <jats:italic>p<\/jats:italic>\u2009=\u20090.038) ratios. The LAVI-to-LASI_v ratio was the most highly correlated shared LA parameter for running (|rho|\u2009=\u20090.403), push-up (rho\u2009=\u20090.335), and sit-up (rho\u2009=\u20090.352) performance. The LAVI-to-mitral E\/e\u2032 ratio was the most highly correlated, independent, and unique LA parameter for running (|rho|\u2009=\u20090.457) performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The LAVI-to-LASI_v ratio, comprising LA size and stiffness information, was the best correlate across exercise types, while the LAVI-to-mitral E\/e\u2032 ratio, comprising LA size and pressure information, was the best correlate of an endurance exercise, i.e., 3-km running performance.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1435818","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T06:44:04Z","timestamp":1738305844000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Associations between left atrial indices and cardiorespiratory and muscular fitness among physically active military personnel"],"prefix":"10.3389","volume":"12","author":[{"given":"Yen-Chen","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pang-Yen","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun-Zhe","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Chun","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chung","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Sui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl J.","family":"Lavie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gen-Min","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"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","volume":"29","author":"Nagueh","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e014682","DOI":"10.1161\/JAHA.119.014682","article-title":"Left atrial volume, cardiorespiratory fitness, and diastolic function in healthy individuals: the HUNT study, Norway","volume":"9","author":"Letnes","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1002\/clc.23180","article-title":"Left atrial function in elite athletes: a meta-analysis of two-dimensional speckle tracking echocardiographic studies","volume":"42","author":"Cuspidi","year":"2019","journal-title":"Clin Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.jcmg.2014.12.032","article-title":"Left atrium size in elite athletes","volume":"8","author":"Iskandar","year":"2015","journal-title":"JACC Cardiovasc Imaging"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e005598","DOI":"10.1161\/CIRCEP.117.005598","article-title":"Does high-intensity endurance training increase the risk of atrial fibrillation?","volume":"11","author":"Opondo","year":"2018","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1161\/CIRCIMAGING.113.001345","article-title":"Morphological and functional adaptation of left and right atria induced by training in highly trained female athletes","volume":"7","author":"D\u2019Ascenzi","year":"2014","journal-title":"Circ Cardiovasc Imaging"},{"key":"B7","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s10554-015-0600-7","article-title":"Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete\u2019s heart","volume":"31","author":"D\u2019Ascenzi","year":"2015","journal-title":"Int J Cardiovasc Imaging"},{"key":"B8","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.jcmg.2022.11.002","article-title":"Prognostic implications of left atrial stiffness Index in heart failure patients with preserved ejection fraction","volume":"16","author":"Kim","year":"2023","journal-title":"Cardiovasc Imaging"},{"key":"B9","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1002\/ejhf.1464","article-title":"Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction","volume":"21","author":"Reddy","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"B10","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.cardfail.2021.10.010","article-title":"Left atrial stiffness Index independently predicts exercise intolerance and quality of life in older patients with obese HFpEF","volume":"28","author":"Singleton","year":"2022","journal-title":"J Card Fail"},{"key":"B11","doi-asserted-by":"publisher","first-page":"464","DOI":"10.4330\/wjc.v8.i8.464","article-title":"Rationale and design of the cardiorespiratory fitness and hospitalization events in armed forces study in eastern Taiwan","volume":"8","author":"Lin","year":"2016","journal-title":"World J Cardiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"888","DOI":"10.6515\/ACS.202311_39(6).20230306F","article-title":"Asian Female athlete\u2019s heart: the CHIEF heart study","volume":"39","author":"Liu","year":"2023","journal-title":"Acta Cardiol Sin"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.725852","article-title":"Athlete\u2019s heart in Asian military males: the CHIEF heart study","volume":"8","author":"Liu","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1110802","DOI":"10.3389\/fphys.2023.1110802","article-title":"Estimated power output for a distance run and maximal oxygen uptake in young adults","volume":"14","author":"Lin","year":"2023","journal-title":"Front Physiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"3386","DOI":"10.1093\/eurheartj\/ehad503","article-title":"Waist-to-height ratio for the obesity paradox in heart failure: is it a matter of fitness?","volume":"44","author":"Lin","year":"2023","journal-title":"Eur Heart J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1093\/ehjci\/jet284","article-title":"Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study","volume":"15","author":"Kou","year":"2014","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B17","doi-asserted-by":"publisher","first-page":"169","DOI":"10.4250\/jcu.2011.19.4.169","article-title":"Use and limitations of E\/e\u2019 to assess left ventricular filling pressure by echocardiography","volume":"19","author":"Park","year":"2011","journal-title":"J Cardiovasc Ultrasound"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2382","DOI":"10.1214\/14-AOS1255","article-title":"Partial distance correlation with methods for dissimilarities","volume":"42","author":"Sz\u00e9kely","year":"2014","journal-title":"The Annals of Statistics"},{"key":"B19","doi-asserted-by":"publisher","first-page":"665","DOI":"10.5351\/CSAM.2015.22.6.665","article-title":"Ppcor: an R package for a fast calculation to semi-partial correlation coefficients","volume":"22","author":"Kim","year":"2015","journal-title":"Commun Stat Appl Methods"},{"key":"B20","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1249\/JSR.0000000000000418","article-title":"Sleep and athletic performance","volume":"16","author":"Watson","year":"2017","journal-title":"Curr Sports Med Rep"},{"key":"B21","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s12970-017-0189-4","article-title":"International society of sports nutrition position stand: nutrient timing","volume":"14","author":"Kerksick","year":"2017","journal-title":"J Int Soc Sports Nutr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"151","DOI":"10.31083\/j.rcm2405151","article-title":"Athlete\u2019s heart: a cardiovascular step-by-step multimodality approach","volume":"24","author":"Palermi","year":"2023","journal-title":"Rev Cardiovasc Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/s12968-017-0416-9","article-title":"Atrial volume and function during exercise in health and disease","volume":"19","author":"Schnell","year":"2016","journal-title":"J Cardiovasc Magn Reson"},{"key":"B24","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.echo.2014.09.013","article-title":"Patterns of left ventricular diastolic function in Olympic athletes","volume":"28","author":"Caselli","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1093\/ehjci\/jeaa183","article-title":"Differing mechanisms of atrial fibrillation in athletes and non-athletes: alterations in atrial structure and function","volume":"21","author":"Trivedi","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B26","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1093\/ehjci\/jeaa084","article-title":"Left atrial enlargement and its association with left atrial strain in university athletes participated in 2015 Gwangju Summer Universiade","volume":"21","author":"Park","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B27","doi-asserted-by":"publisher","first-page":"403","DOI":"10.2147\/DMSO.S34220","article-title":"Predicting cardiometabolic risk: waist-to-height ratio or BMI. A meta-analysis","volume":"6","author":"Savva","year":"2013","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B28","doi-asserted-by":"publisher","first-page":"271","DOI":"10.4330\/wjc.v13.i8.271","article-title":"Potential role of an athlete-focused echocardiogram in sports eligibility","volume":"13","author":"Palermi","year":"2021","journal-title":"World J Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1435818\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T06:44:10Z","timestamp":1738305850000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1435818\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,31]]},"references-count":28,"alternative-id":["10.3389\/fcvm.2025.1435818"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1435818","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,31]]},"article-number":"1435818"}}