Early Myocardial Dysfunction After Chronic Use of Anabolic Androgenic Steroids: Combined Pulsed-Wave Tissue Doppler Imaging and Ultrasonic Integrated Backscatter Cyclic Variations Analysis

Montisci, Roberta; Cecchetto, Giovanni; Ruscazio, Massimo; Snenghi, Rossella; Portale, Anna; Viel, Guido; Nalesso, Alessandro; Paoli, Antonio; Iliceto, Sabino; Meloni, Luigi; Ferrara, Santo Davide; Montisci, Massimo

doi:10.1016/j.echo.2010.03.005

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 5 , Pages 516-522, May 2010

Early Myocardial Dysfunction After Chronic Use of Anabolic Androgenic Steroids: Combined Pulsed-Wave Tissue Doppler Imaging and Ultrasonic Integrated Backscatter Cyclic Variations Analysis

Roberta Montisci, MD, PhD
- Clinical Cardiology, University of Cagliari, Cagliari, Italy
Giovanni Cecchetto, MD
- Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
- Reprint requests: Giovanni Cecchetto, MD, University of Padova, Forensic Toxicology and Antidoping Unit, Via Falloppio, 50, 35121 Padova, Italy.
Massimo Ruscazio, MD
- Clinical Cardiology, University of Cagliari, Cagliari, Italy
Rossella Snenghi, MD
- Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
Anna Portale, MD
- Department of Cardiology, University of Padova, Padova, Italy
Guido Viel, MD
- Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
Alessandro Nalesso, CD
- Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
Antonio Paoli, MD
- Department of Anatomy and Physiology, University of Padova, Padova, Italy
Sabino Iliceto, MD
- Department of Cardiology, University of Padova, Padova, Italy
Luigi Meloni, MD
- Clinical Cardiology, University of Cagliari, Cagliari, Italy
Santo Davide Ferrara, MD, PhD
- Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
Massimo Montisci, MD, PhD
- Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy

published online 12 April 2010.

Background

The chronic consumption of androgenic anabolic steroids (AAS) has shown to cause subclinical impairment of myocardial function. Pulsed-wave Doppler tissue imaging (PWDTI) detects early regional alterations of ventricular function, whereas integrated backscatter cyclic variations (IBScv) are tightly related to the contractile efficiency of the left ventricular wall. The aim of this study was to identify the effects of chronic AAS misuse on myocardial function using both PWDTI and IBScv.

Methods

Twenty-eight male bodybuilders (11 AAS users, 17 AAS nonusers) and 20 healthy sedentary subjects (controls), matched according to age, were studied. To assess left ventricular function, each subject underwent standard Doppler echocardiography, PWDTI, and IBScv analyses.

Results

Left ventricular mass was significantly higher in AAS users than in AAS nonusers and controls. Global systolic function (assessed by determining the ejection fraction) was similar in all subjects, but isovolumetric relaxation time was significantly higher in AAS users than in controls. On PWDTI analysis, AAS users showed regional systolic and diastolic dysfunction (evaluated by measuring s′, e′, and a′) not detectable in the other two groups. IBScv identified regional systolic impairment only in AAS users at the level of the left ventricular inferior wall.

Conclusions

The present study confirms that in AAS users, PWDTI and IBScv are effective and reliable noninvasive diagnostic tools for detecting early abnormalities of the systolic and diastolic longitudinal myocardial function, probably related to an increase in myocardial collagen content, interpretable as a repair process against the direct cellular injury produced by AAS.

Keywords: Anabolic steroids, Bodybuilders, Doping, Pulsed-wave Doppler tissue imaging, Integrated backscatter cyclic variations

Abbreviations: A, Late diastolic wave, AAS, Androgenic anabolic steroids, á, Late diastolic myocardial velocity, BSA, Body surface area, E, Early diastolic wave, é, Early diastolic myocardial velocity, IBScv, Integrated backscatter cyclic variations, IVRT, Isovolumetric relaxation time, LV, Left ventricular, PWDTI, Pulsed-wave Doppler tissue imaging, S, Myocardial systolic wave