The impact of anabolic androgenic steroids abuse and type of training on left ventricular remodeling and function in competitive athletes

Abstract

Background/Aim. Long-term intensive training is associated with distinctive cardiac adaptations which are known as athlete?s heart. The aim of this study was to determine whether the use of anabolic androgenic steroids (AAS) could affect echocardiographic parameters of left ventricular (LV) morphology and function in elite strength and endurance athletes. Methods. A total of 20 elite strength athletes (10 AAS users and 10 non-users) were compared to 12 steroid-free endurance athletes. All the subjects underwent comprehensive standard echocardiography and tissue Doppler imaging. Results. After being indexed for body surface area, both left atrium (LA) and LV end-diastolic diameter (LVEDD) were significantly higher in the endurance than strength athletes, regardless of AAS use (p < 0.05, for both). A significant correlation was found between LA diameter and LVEDD in the steroid-free endurance athletes, showing that 75% of LA size variability depends on variability of LVEDD (p < 0.001). No significant differences in ejection fraction and cardiac output were observed among the groups, although mildly reduced LV ejection fraction was seen only in the AAS users. The AAS-using strength athletes had higher A-peak velocity when compared to steroidfree athletes, regardless of training type (p < 0.05 for both). Both AAS-using and AAS-free strength athletes had lower e? peak velocity and higher E/e? ratio than endurance athletes (p < 0.05, for all). Conclusions. There is no evidence that LV ejection fraction in elite athletes is altered by either type of training or AAS misuse. Long-term endurance training is associated with preferable effects on LV diastolic function compared to strength training, particularly when the latter is combined with AAS abuse.Uvod/Cilj. Dugotrajni intenzivni trening povezan je sa adaptivnim promenama srcanog misica poznatim kao sportsko srce. Cilj rada bio je da se utvrdi uticaj primene anabolickih androgenih steroida (AAS) na ehokardiografske parametre morfologije i funkcije leve komore (LV) kod elitnih sportista koji se bave sportovima snage i izdrzljivosti. Metode. Dvadeset elitnih sportista snage (10 korisnika AAS i 10 onih koji ne koriste AAS) uporedjeni su sa 12 sportista izdrzljivosti koji ne koriste AAS. Svi ispitanici bili su podvrgnuti standardnom ehokardiografskom pregledu sa tkivnim Dopler-om. Rezultati. Nakon indeksiranja prema telesnoj povrsini, leva pretkomora (LA) i end-dijastolni precnik leve komore (LVEDD) bili su znacajno veci kod sportista izdrzljivosti nego kod sportista snage, bez obzira na uzimanje AAS (p < 0,05, za oba). Nadjena je znacajna korelacija izmedju velicine LA i LVEDD kod sportista izdrzljivosti koji ne uzimaju AAS, koja pokazuje da 75% varijablnosti velicine LA zavisi od varijabilnosti LVEDD (p < 0,001). Nije pokazana znacajna razlika u ejekcionoj frakciji (EF) LV (LVEF) i minutnom volumenu izmedju grupa, mada je blago snizena LVEF vidjena samo kod sportista koji koriste AAS. Sportisti snage koji koriste AAS imali su vecu vrednost pika A-talasa u poredjenju sa sportistima koji ne koriste AAS, bez obzira na tip treninga (p < 0,05 za oba). Sportisti snage, bez obzira na primenu AAS, imali su nize vrednosti brzine e? talasa i veci E/e? odnos u poredjenju sa sportistima izdrzljivosti (p < 0,05 za sve). Zakljucak. Nema dokaza da je primena AAS povezana sa promenom LVEF, bez obzira na tip treninga. Dugorocni trening izdrzljivosti povezan je sa povoljnim efektima na dijastolnu funkciju LV u poredjenju sa treningom snage, pogotovu ako je trening snage povezan sa zloupotrebom AAS.