Right Ventricle Involvement in Tako-Tsubo Cardiomyopathy.

We appreciate the kind comments of Dr. SanchezGomar and colleagues about our meta-analysis of left atrial (LA) size in athletes (1) as well as their novel use of cardiac magnetic resonance to assess LA volume more accurately in older former elite endurance athletes. Their results suggest that LA size adjusted for body surface area is almost 50% (58 14 ml/m vs. 39 14 ml/m) greater in their athletes than control subjects, a percentage difference much greater than the 30% (30.9 1.4 ml/m vs. 24.1 1.0 ml/m) that we observed in our metaanalysis, probably because the athletes in the study by Dr. Sanchez-Gomar and colleagues were older (age 57.0 4.3 years) than those in our study (age 27 4 years) (1), and all were formerly elite endurance competitors. Sanchez-Gomar et al. consider the increase in LA size noted in both of our studies as “an overall benign adaptation.” This may be true, but the risk of atrial fibrillation (AF) increases with LA size, and it is not clear that an increase in LA size from endurance training presents less risk of AF than other causes of LA enlargement. Indeed, increased LA size may be 1 explanation for the possible increase in AF noted in endurance athletes (2).