Ventricular structure, function, and focal fibrosis in anabolic steroid users: a CMR study.
OBJECTIVE
Anabolic steroid (AS) misuse is widespread amongst recreational bodybuilders; however, their effects on the cardiovascular system are uncertain. Our aim was to document the impact of AS use on cardiac structure, function and the presence of focal fibrosis using the gold standard cardiovascular magnetic resonance imaging (CMR).


METHODS
A cross-sectional cohort design was utilised with 21 strength-trained participants who underwent CMR imaging of the heart and speckle-tracking echocardiography. Thirteen participants (30 ± 5 years) taking AS for at least 2 years and currently on a "using"-cycle were compared with age and training-matched controls (n = 8; 29 ± 6 years) who self-reported never having taken AS (NAS).


RESULTS
AS users had higher absolute left ventricular (LV) mass (220 ± 45 g) compared to NAS (163 ± 27 g; p < 0.05) but this difference was removed when indexed to fat-free mass. AS had a reduced right ventricular (RV) ejection fraction (AS 51 ± 4 % vs. NAS 59 ± 5 %; p < 0.05) and a significantly lower left ventricular E':A' myocardial tissue velocity ratio [AS 0.99(0.54) vs. NAS 1.78(0.46) p < 0.05] predominantly due to greater tissue velocities with atrial contraction. Peak LV longitudinal strain was lower in AS users (AS -14.2 ± 2.7 % vs. NAS -16.6 ± 1.9 %; p < 0.05). There was no evidence of focal fibrosis in any participant.


CONCLUSIONS
AS use was associated with significant LV hypertrophy, albeit in-line with greater fat-free mass, reduced LV strain, diastolic function, and reduced RV ejection fraction in male bodybuilders. There was, however, no evidence of focal fibrosis in any AS user.
Health Sciences Department, Liverpool Hope University, Hope Park, Liverpool, L16 9JD, UK, angellp@hope.ac.uk.
Peter J
PJ
Angell
Tevfik F
TF
Ismail
Andrew
A
Jabbour
Gillian
G
Smith
Annette
A
Dahl
Ricardo
R
Wage
Greg
G
Whyte
Daniel J
DJ
Green
Sanjay
S
Prasad
Keith
K
George
D000293:Adolescent; D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects*; D006332:Cardiomegaly / Q000139:chemically induced; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005355:Fibrosis / Q000139:chemically induced; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000009:adverse effects*; D016276:Ventricular Function
D045930:Anabolic Agents; D013256:Steroids