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

      Affiliations

    • Clinical Cardiology, University of Cagliari, Cagliari, Italy
    • ,
  • Giovanni Cecchetto, MD

      Affiliations

    • Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
    • Corresponding Author InformationReprint requests: Giovanni Cecchetto, MD, University of Padova, Forensic Toxicology and Antidoping Unit, Via Falloppio, 50, 35121 Padova, Italy.
    • ,
  • Massimo Ruscazio, MD

      Affiliations

    • Clinical Cardiology, University of Cagliari, Cagliari, Italy
    • ,
  • Rossella Snenghi, MD

      Affiliations

    • Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
    • ,
  • Anna Portale, MD

      Affiliations

    • Department of Cardiology, University of Padova, Padova, Italy
    • ,
  • Guido Viel, MD

      Affiliations

    • Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
    • ,
  • Alessandro Nalesso, CD

      Affiliations

    • Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
    • ,
  • Antonio Paoli, MD

      Affiliations

    • Department of Anatomy and Physiology, University of Padova, Padova, Italy
    • ,
  • Sabino Iliceto, MD

      Affiliations

    • Department of Cardiology, University of Padova, Padova, Italy
    • ,
  • Luigi Meloni, MD

      Affiliations

    • Clinical Cardiology, University of Cagliari, Cagliari, Italy
    • ,
  • Santo Davide Ferrara, MD, PhD

      Affiliations

    • Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy
    • ,
  • Massimo Montisci, MD, PhD

      Affiliations

    • Forensic Toxicology and Antidoping Unit, University of Padova, Padova, Italy

References 

  1. Melchert RB, Welder AA. Cardiovascular effects of androgenic-anabolic steroids. Med Sci Sports Exerc. 1995;27:1252–1262
  2. Santamarina RD, Besocke AG, Romano LM, Ioli PL, Gonorazky SE. Ischemic stroke related to anabolic abuse. Clin Neuropharmacol. 2008;31:80–85
  3. Hausmann R, Hammer S, Betz P. Performance enhancing drugs (doping agents) and sudden death—a case report and review of the literature. Int J Legal Med. 1998;111:261–264
  4. Kindermann W. Cardiovascular side effects of anabolic-androgenic steroids. Herz. 2006;31:566–573
  5. Payne JR, Kotwinski PJ, Montgomery HE. Cardiac effects of anabolic steroids. Heart. 2004;90:473–475
  6. Al-Zahrani GB, Bellavia D, Pellikka PA, Dispenzieri A, Hayman SR, Oh JK, et al. Doppler myocardial imaging compared to standard two-dimensional and Doppler echocardiography for assessment of diastolic function in patients with systemic amyloidosis. J Am Soc Echocardiogr. 2009;22:290–298
  7. Di Cori A, Bongiorni MG, Zucchelli G, Soldati E, Falorni M, Segreti L, et al. Early left ventricular structural myocardial alterations and their relationship with functional and electrical properties of the heart in myotonic dystrophy type 1. J Am Soc Echocardiogr. 2009;22:1173–1179
  8. Saghir M, Areces M, Makan M. Strain rate imaging differentiates hypertensive cardiac hypertrophy from physiologic cardiac hypertrophy (athlete's heart). J Am Soc Echocardiogr. 2007;20:151–157
  9. D'Andrea A, Caso P, Salerno G, Scarafile R, De Corato G, Mita C, et al. Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis. Br J Sports Med. 2007;41:149–155
  10. Nottin S, Nguyen LD, Terbah M, Obert P. Cardiovascular effects of androgenic anabolic steroids in male bodybuilders determined by tissue Doppler imaging. Am J Cardiol. 2006;97:912–915
  11. Wickline SA, Thomas LJ, Miller JG, Sobel BE, Pérez JE. The dependence of myocardial ultrasonic integrated backscatter on contractile performance. Circulation. 1985;72:183–192
  12. Lythall DA, Bishop J, Greenbaum RA, Ilsley CJ, Mitchell AG, Gibson DG, et al. Relationship between myocardial collagen and echo amplitude in non-fibrotic hearts. Eur Heart J. 1993;14:344–350
  13. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–1463
  14. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–133
  15. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28:1462–1536
  16. Hildick-Smith DJ, Shapiro LM. Echocardiographic differentiation of pathological and physiological left ventricular hypertrophy. Heart. 2001;85:615–619
  17. D'Andrea A, Limongelli G, Caso P, Sarubbi B, Della Pietra A, Brancaccio P, et al. Association between left ventricular structure and cardiac performance during effort in two morphological forms of athlete′s heart. Int J Cardiol. 2002;86:177–184
  18. Di Bello V, Lattanzi F, Picano E, Talarico L, Caputo MT, Di Muro C, et al. Left ventricular performance and ultrasonic myocardial quantitative reflectivity in endurance senior athletes: an echocardiographic study. Eur Heart J. 1993;14:358–363
  19. Huston TP, Puffer JC, Rodney WM. The athletic heart syndrome. N Engl J Med. 1985;313:24–32
  20. Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol. 1986;7:190–203
  21. Pelliccia A, Culasso F, Di Paolo FM, Maron BJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med. 1999;130:23–31
  22. Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE. The athlete's heart. A meta-analysis of cardiac structure and function. Circulation. 2000;101:336–344
  23. Sullivan ML, Martinez CM, Gennis P, Gallagher EJ. The cardiac toxicity of anabolic steroids. Prog Cardiovasc Dis. 1998;41:1–15
  24. Nieminen MS, Ramo MP, Viitasalo M, Heikkila P, Karjalainen J, Mantysaari M, et al. Serious cardiovascular side effects of large doses of anabolic steroids in weight lifters. Eur Heart J. 1996;17:1576–1583
  25. Dickerman RD, Schaller F, McConathy WJ. Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid Use. Cardiology. 1998;90:145–148
  26. Palatini P, Giada F, Garavelli G, Sinisi F, Mario L, Michieletto M, et al. Cardiovascular effects of anabolic steroids in weight-trained subjects. J Clin Pharmacol. 1996;36:1132–1140
  27. Sader MA, Griffiths KA, McCredie RJ, Handelsman DJ, Celermajer DS. Androgenic anabolic steroids and arterial structure and function in male bodybuilders. J Am Coll Cardiol. 2001;37:224–230
  28. Thompson PD, Sadaniantz A, Cullinane EM, Bodziony KS, Catlin DH, Torek-Both G, et al. Left ventricular function is not impaired in weight-lifters who use anabolic steroids. J Am Coll Cardiol. 1992;19:278–282
  29. Di Bello V, Giorgi D, Bianchi M, Bertini A, Caputo MT, Valenti G, et al. Effects of anabolic-androgenic steroids on weight-lifters' myocardium: an ultrasonic videodensitometric study. Med Sci Sports Exerc. 1999;31:514–521
  30. Urhausen A, Albers T, Kindermann W. Are the cardiac effects of anabolic steroid abuse in strength athletes reversible?. Heart. 2004;90:496–501
  31. D'Andrea A, D'Andrea L, Caso P, Scherillo M, Zeppilli P, Calabro R. The usefulness of Doppler myocardial imaging in the study of the athlete′s heart and in the differential diagnosis between physiological and pathological ventricular hypertrophy. Echocardiography. 2006;23:149–157
  32. Palka P, Lange A, Fleming AD, Donnelly JE, Dutka DP, Starkey IR, et al. Differences in myocardial velocity gradient measured throughout the cardiac cycle in patients with hypertrophic cardiomyopathy, athletes and patients with left ventricular hypertrophy due to hypertension. J Am Coll Cardiol. 1997;30:760–768
  33. Shan K, Bick RJ, Poindexter BJ, Shimoni S, Letsou GV, Reardon MJ, et al. Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans. J Am Coll Cardiol. 2000;36:891–896
  34. Caso P, D'Andrea A, Galderisi M, Liccardo B, Severino S, De Simone L, et al. Pulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and myocardial regional diastolic function. Am J Cardiol. 2000;85:1131–1136
  35. Caso P, Galderisi M, D'Andrea A, Di Maggio D, De Simone L, Martiniello AR, et al. Analysis by pulsed Doppler tissue imaging of ventricular interaction in long-distance competitive swimmers. Am J Cardiol. 2002;90:193–197
  36. D'Andrea A, Caso P, Sarubbi B, Limongelli G, Liccardo B, Cice G, et al. Right ventricular myocardial adaptation to different training protocols in top-level athletes. Echocardiography. 2003;20:329–336
  37. Mizuno R, Fujimoto S, Saito Y, Nakamura S. Non-invasive quantitation of myocardial fibrosis using combined tissue harmonic imaging and integrated backscatter analysis in dilated cardiomyopathy. Cardiology. 2007;108:11–17
  38. Maceira AM, Barba J, Varo N, Beloqui O, Diez J. Ultrasonic backscatter and serum marker of cardiac fibrosis in hypertensives. Hypertension. 2002;39:923–928
  39. Hoyt RM, Skorton DJ, Collins SM, Melton HE. Ultrasonic backscatter and collagen in normal ventricular myocardium. Circulation. 1984;69:775–782
  40. Maceira AM, Barba J, Beloqui O, Diez J. Ultrasonic backscatter and diastolic function in hypertensive patients. Hypertension. 2002;40:239–243
  41. Hoyt RH, Collins SM, Skorton DJ, Ericksen EE, Conyers D. Assessment of fibrosis in infarcted human hearts by analysis of ultrasonic backscatter. Circulation. 1985;71:740–744
  42. Zaugg M, Jamali NZ, Lucchinetti E, Xu W, Alam M, Shafiq SA, et al. Anabolic-androgenic steroids induce apoptotic cell death in adult rat ventricular myocytes. J Cell Physiol. 2001;187:90–95

PII: S0894-7317(10)00225-7

doi: 10.1016/j.echo.2010.03.005

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

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