Associations between left atrial indices and cardiorespiratory and muscular fitness among physically active military personnel

Yen-Chen Lin; Pang-Yen Liu; Kun-Zhe Tsai; Wei-Chun Huang; Wen-Chung Yu; Xuemei Sui; Carl J Lavie; Gen-Min Lin

doi:10.3389/fcvm.2025.1435818

Associations between left atrial indices and cardiorespiratory and muscular fitness among physically active military personnel

Front Cardiovasc Med. 2025 Jan 31:12:1435818. doi: 10.3389/fcvm.2025.1435818. eCollection 2025.

Authors

Yen-Chen Lin^{1

2}, Pang-Yen Liu³, Kun-Zhe Tsai^{4

5

6}, Wei-Chun Huang^{7

8}, Wen-Chung Yu^{9

10}, Xuemei Sui¹¹, Carl J Lavie¹², Gen-Min Lin^{3

4}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.
⁵ Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei, Taiwan.
⁶ Department of Periodontology, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁷ Department of Medicine, Pingtung Christian Hospital, Pingtung City, Pingtung, Taiwan.
⁸ Department of Business Management, National Sun Yat-sen University, Kaohsiung City, Taiwan.
⁹ College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁰ Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹¹ Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
¹² John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States.

Abstract

Background: 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.

Objectives: This study aimed to identify correlations between echocardiographic LA size, pressure, stiffness, and composite indices, and various exercise performance indicators.

Methods: Echocardiographic parameters were obtained from 181 physically active military personnel receiving regular training and tests for a 3-km run and 2 min 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'). 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.

Results: The top 16% of runners vs. controls had a lower LASI based on LA volume changes (LASI_v, 0.196 vs. 0.245, p = 0.013) and higher LAVI-to-LASI_v (12.30 vs. 8.08, p = 0.001) and LAVI-to-(mitral E/e') (4.37 vs. 3.76, p = 0.038) ratios. The LAVI-to-LASI_v ratio was the most highly correlated shared LA parameter for running (|rho| = 0.403), push-up (rho = 0.335), and sit-up (rho = 0.352) performance. The LAVI-to-mitral E/e' ratio was the most highly correlated, independent, and unique LA parameter for running (|rho| = 0.457) performance.

Conclusions: 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' ratio, comprising LA size and pressure information, was the best correlate of an endurance exercise, i.e., 3-km running performance.

Keywords: athletes; echocardiography; exercise performance; left atrial stiffness index (LASI); left atrial strain; left atrial volume index (LAVI).