Abstract

Background: Anabolic androgenic steroids (AAS) are sometimes used by power athletes in order 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 reparative mechanism against a myocardial damage.

Objective: To investigate potential underlying left ventricular (LV) myocardial dysfunction after chronic abuse 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 in 45 bodybuilders, including 20 athletes abusing AAS from at least 5 years (users), in 25 anabolic-free body-builders (non-users), as well as in 25 age-matched healthy sedentary controls, all males. In users, the mean number of weeks of AAS use per year was 31.3±6.4 over 8.9±3.8 years, and the mean weekly dosage of AAS was 525.4±90.7 mg.

Results: the groups were matched for age, while systolic blood pressure was higher in athletes (145±9 vs. 130±5 mm Hg) than in controls. LV mass index did not significantly differ between the 2 groups of athletes. In particular, both users and non-users showed increased wall thickness and relative wall thickness compared with controls, while LV ejection fraction, LV end-diastolic diameter and transmitral Doppler indexes were comparable among the three groups. Color DMI analysis showed in users significantly lower Em/Am ratios at the level of basal interventricular septum (IVS) and LV lateral wall (p<0.01), in comparison with both non-users and controls. In addition, in users peak systolic LV SR and strain were both reduced in middle IVS (both p<0.001) and LV lateral free wall (both p<0.01). By stepwise forward multivariate analyses, the sum of LV wall thickness (β coefficient = - 0.32, p < 0.01), the number of weeks of AAS use per year (β = - 0.42, p < 0.001) and the weekly dosage of AAS (β = - 0.48, p<0.001) were the only independent determinants of middle IVS SR. In addition, impaired LV strain in users was associated with a reduced performance during physical effort (p<0.001).

Conclusions: several years after chronic abuse of AAS, strength athletes show a sub-clinical impairment of both systolic and diastolic myocardial function, strongly associated with mean dosage and time duration of AAS use. The combined use of DMI and SRI may be therefore useful for early identifying patients with more diffused cardiac involvement, and eventually to investigate the reversibility of such myocardial effect after discontinuation of the drug.