P4132Decreased myocardial native T1 times and impaired myocardial contractility in young anabolic androgenic steroids users
Authors: Souza F R , Santos M R , Santos R P , Leite I S L , Jordao C P , Fonseca G W P , Oliveira T F , Yonamine M , Pereira R M R , Negrao C E , Rochitte C E , Alves M J N N 
Published: October 2019

Abstract

Background
Anabolic androgenic steroids (AAS) have been associated with several injuries on the cardiovascular system. AAS abuse may have a direct toxic effect on the myocardium that could lead to cardiac function and structure alterations. Clinical and forensic cases have been reported myocardial fibrosis in AAS users. Myocardial fibrosis increases the risk of heart failure and sudden death. However, recent studies did not show evidence of focal myocardial fibrosis and diffuse myocardial fibrosis in AAS users using T1-mapping techniques. Thus, it remains unclear the association between AAS and cardiac structure alterations.

Purpose
The aim of this study was to evaluate cardiac structure by cardiovascular magnetic resonance (CMR) imaging with late-gadolinium enhancement (LGE), cardiac T1-mapping and extracellular volume measurements (ECV). Additionally, we also evaluated the cardiac contractility by CMR and echocardiography in young AAS users.

Methods
Twenty strength-trained AAS users (AASU) age 29±5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled. Cardiac structure was assessed by LGE, native T1-mapping and ECV. Cardiac contractility was evaluated as cardiac strain measured by CMR (feature tracking imaging technique) and echocardiography (speckle tracking technique).

Results
Global native T1 times [753 (683–870) vs 916 (815–1239) vs 1205 (825–1242) ms, respectively, p=0.03], and native T1 times at the left ventricle mid-ventricular slice [813 (695–1096) vs 922 (825–1095) vs 1140 (840–1322) ms, respectively, p=0.03] were lower in AASU compared with AASNU and SC. Mid-ventricular ECV was similar between AASU, AASNU and SC (22±6 vs 23±4 vs 24±4%, respectively, p=0.37). Focal myocardial fibrosis was found in 2 individuals (11%) of AASU. The mid anteroseptal and mid inferoseptal were the most affected segments. The total estimated mass of the LV mass was 1.25 g (0.65%). Three participants of SC showed focal myocardial fibrosis. The mid anterolateral, mid inferolateral and mid inferomedial were the most affected segments. The total estimated mass of the LV mass was 3.43 g (2.30%). In contrast, none of the AASNU had myocardial fibrosis. By CMR, AASU showed a lower medial radial strain (30±8 vs. 38±6%, p<0.01), medial circumferential strain (−17±3 vs −20±2%, p<0.01) and global longitudinal strain (−17±3 vs −20±3%, p<0.01) compared with AASNU. Echocardiography also demonstrated a lower 4CH longitudinal strain in AASU compared with AASNU (−15.5±3 vs −18.3±2%, p=0.03). Moreover, the AASU shower a higher left ventricle mass compared with AASNU and SC (185±20 vs 130±17 vs 112±14 g, respectively, p<0.01).

Conclusion
This study indicates that AAS abuse may be associated with decreased myocardial native T1 times, impaired myocardial contractility and focal myocardial fibrosis. These myocardial structural and functional alterations may be associated to unadapted cardiac hypertrophy in young AAS users.

Acknowledgement/Funding
Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP], Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes).