Myocardial Scar Detected by Cardiovascular Magnetic Resonance in a Competitive Bodybuilder With Longstanding Abuse of Anabolic Steroids

Abstract

Introduction:The self-administration intake of anabolic-androgenic steroids (AAS) is a widespread practice in competitive bodybuilders. Structural changes within the myocardium following AAS abuse including hypertrophy, restricted diastolic function as well as systolic dysfunction and impaired ventricular inflow have been reported.Case Presentation:We present the case of a 39-year-old bodybuilder with a more than 20-year history of anabolic-androgenic steroids (AAS) abuse presenting with increasing exertional dyspnoea and fatigue. Diagnostic work-up of the patient’s current symptoms included a cine cardiovascular magnetic resonance (CMR). Using a T1-weighted inversion-recovery sequence 10 minutes after application of 0.1 mmol/kg gadolinium with diethylenetriaminepentaacetic acid (gadolinium DTPA), patchy midwall enhancement in the septal and posterolateral region of the left ventricle was demonstrated. This enhancement pattern is different from the enhancement pattern found in patients with ischemic heart disease.Conclusions:The present case illustrates for the first time, by CMR, myocardial scarring with severe left ventricular hypertrophy in a patient with normal coronary arteries after long lasting abuse of AAS. With that finding we could demonstrate a link between AAS abuse and the occurrence of myocardial scarring in humans. This finding may help raise awareness of the consequences of AAS use.

Anabolic Steroids and Cardiovascular Outcomes: The Controversy

“…Golestani et al proposed the use of molecular imaging as a method for early detection for CVD in AS users [34]. Baumann et al reported myocardial scaring and cardiomegaly, diagnosed by MRI in a male bodybuilder with 20 years of AS use [35]. Alizade et al found an increase in right ventricular heart strain with the use of a two-dimensional speckle tracking echocardiography [36].…”

Anabolic-androgenic steroids and cardiovascular risk

“…Additionally, a clinical case report showed that AAS abusers with normal coronary arteries were diagnosed with left ventricular hypertrophy with myocardial scarring. [52] It was also suggested that AAS induces myocardial apoptosis. These studies indicated that AAS had a pro-apoptotic effect on cardiac myocytes.…”

Annual banned‐substance review: analytical approaches in human sports drug testing

“…Further, the functionality of muscles associated with respiration is vital, and clinical situations such as severe cachexia necessitate therapeutic interventions based on anabolic agents. [36] However, the enormous breadth of yet inevitable undesirable effects of anabolic agents, particularly anabolic-androgenic steroids (AAS), continuously results in reports on risks, [37][38][39][40][41][42][43][44][45][46] documented health damages, [47][48][49][50][51][52][53][54] and fatalities [55] plausibly connected to (long-term) AAS abuse. Despite this steadily growing body of evidence concerning AASrelated adverse health effects, the class of anabolic agents (in particular AAS) has again been most frequently reported with regard to adverse analytical findings in doping control samples.…”

“…Besides the commonly collected specimens of urine, serum, and whole blood, a growing interest in alternative test matrices such [27][28][29]31,33,35] S1 Anabolic Agents 1 Anabolic androgenic steroids [36][37][38][39][43][44][45][46][47][48][49][50][51][52][53][54][55][56] a. exogenous [63][64][65]67,69,70] 2 Other anabolic agents - [85,86,92,93] - [60,[87][88][89][90][91][92] S2 Peptide hormones, growth factors, related substances and mimetics 1 Erythropoiesis-Stimulating Agents [119] [ 27,33,105,106,112] - [24,27,…”