Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis

Abstract

Background: Anabolic androgenic steroids (AAS) are sometimes used by power athletes to improve performance by increasing muscle mass and strength. Recent bioptical data have shown that in athletes under the pharmacological effects of AAS, a focal increase in myocardial collagen content might occur as a repair mechanism against myocardial damage. Objective: To investigate the potential underlying left ventricular myocardial dysfunction after chronic misuse of AAS in athletes by use of Doppler myocardial imaging (DMI) and strain rate imaging (SRI). Methods: Standard Doppler echocardiography, DMI, SRI and ECG treadmill test were undertaken by 45 bodybuilders, including 20 athletes misusing AAS for at least 5 years (users), by 25 anabolic-free bodybuilders (non-users) and by 25 age-matched healthy sedentary controls, all men. The mean (SD) number of weeks of AAS use per year was 31.3 (6.4) in users, compared with 8.9 (3.8) years in non-users, and the mean weekly dosage of AAS was 525.4 (90.7) mg. Results: The groups were matched for age. Systolic blood pressure was higher in athletes (145 (9) vs 130 (5) mm Hg) than in controls. Left ventricular mass index did not significantly differ between the two groups of athletes. In particular, both users and non-users showed increased wall thickness and relative wall thickness compared with controls, whereas left ventricular ejection fraction, left ventricular end-diastolic diameter and transmitral Doppler indexes were comparable for the three groups. Colour DMI analysis showed significantly lower myocardial early: myocardial atrial diastolic wave ratios in users at the level of the basal interventricular septum (IVS) and left ventricular lateral wall (p,0.01), in comparison with both non-users and controls. In addition, in users, peak systolic left ventricular strain rate and strain were both reduced in the middle IVS (both p,0.001) and in the left ventricular lateral free wall (both p,0.01). By stepwise forward multivariate analyses, the sum of the left ventricular wall thickness (b coefficient = 20.32, p,0.01), the number of weeks of AAS use per year (b = 20.42, p,0.001) and the weekly dosage of AAS (b = 20.48, p,0.001) were the only independent determinants of middle IVS strain rate. In addition, impaired left ventricular strain in users was associated with a reduced performance during physical effort (p,0.001). Conclusions: Several years after chronic misuse of AAS, power athletes show a subclinical impairment of both systolic and diastolic myocardial function, strongly associated with mean dosage and duration of AAS use. The combined use of DMI and SRI may therefore be useful for the early identification of patients with more diffused cardiac involvement, and eventually for investigation of the reversibility of such myocardial effects after discontinuation of the drug.

Androgens in cardiac fibrosis and other cardiovascular mechanisms

“…Some influences of testosterone on cardiac function and morphology have been established. This is primarily in regard to a nonphysiologic situation of testosterone misuse when the side-effects include left ventricular hypertrophy with systolic and diastolic dysfunction [2,3]. However, in patients with heart failure and reduced left ventricular ejection fraction, testosterone supplementation significantly improves exercise capacity in both men and women, without affecting left ventricular systolic function [4][5][6][7][8].…”

Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy

“…These include increases in salt and water retention, 30–32 which can lead to edema, hypertension, and heart failure; increases in the risk for coagulation and platelet aggregation, which can lead to an increased risk of stroke or MI 33 ; and the possibility of left ventricular hypertrophy and systolic and diastolic dysfunction. 34,35 Given the broad range of proposed biological pathways, further examination of these mechanisms is important.…”

Performance enhancing drug abuse and cardiovascular risk in athletes: implications for the clinician

“…AS use has been associated with an increase in LV mass,35 36 but there is conflicting data 27 37 38. There are some data in AS users that suggest a reduction in systolic cardiac function38 although this is not a consistent finding between studies 8.…”

“…There are some data in AS users that suggest a reduction in systolic cardiac function38 although this is not a consistent finding between studies 8. A reduction in diastolic function has been observed more frequently and it has been suggested that a reduction in myocardial relaxation/elastance is associated with AS use 27 37 38. AS use has also been associated with reduced endothelial function in conduit arteries 6 24 39.…”