Bi-ventricular structure and function in resistance trained athletes using anabolic androgenic steroids as determined by three-dimensional echocardiography
Authors: Johnson C S , Morrison B N , Chester N , Stansfield B , Sculthorpe N , Cooper R , George K , Oxborough D 
Published: June 2024

Abstract

Background
Anabolic androgenic steroids (AAS) are frequently used by resistance trained (RT) individuals and their use has been shown to have a negative impact on left ventricular (LV) structure and function albeit with limited evidence pertaining to the impact on the right ventricle (RV). Three-dimensional echocardiography (3DE) is preferred over two-dimensional imaging for better delineating ventricular structure alongside providing capacity for 3DE derived strain imaging.

Purpose
To determine 3DE derived bi-ventricular structure and function in RT athletes in 1) current users (CU), 2) past users (PU) and 3) non-users (NU) of AAS.

Methods
Thirty-four RT athletes (28 male and 6 female) (&gt;4hrs dedicated RT per week) were recruited into the study. Athletes self-reported as CU (n=14), PU (n=9) and NU (n=11). All athletes underwent assessment of anthropometrics (height, weight and fat free mass (FFM), blood pressure and 3DE to obtain measures of LV structure (LV end diastolic volume (EDV) and LV mass (LVM)) and function (LV ejection fraction (EF), global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS) and torsion and RV structure (RV EDV) and function (RV EF and tricuspid plane systolic excursion (TAPSE)). All structural indices were scaled to FFM.

Results
Participant demographics are presented in figure 1. CU had significantly larger absolute values of both LV and RV size (cavity and mass) compared to both PU and NU however these differences disappeared when scaled to FFM (LV mass = 2.5±0.3 vs 2.3±0.3 and 2.4±0.3 g/kg, LV EDV = 2.3±0.2 vs 2.3±0.2 and 2.3±0.2 ml/kg, RV EDV = 1.0±0.7 vs 1.2±0.8 and 1.3±0.5 ml/kg; P&lt;0.05 for CU, PU and NU respectively). Left ventricular function was reduced in CU compared to both PU and NU and PU to NU for GLS (-10.9±2 vs -12.6±1 and -15.3±1.5 %; P&lt;0.05), GAS (-21.8±4.4 vs -23.4±2.3 and -27.5±1.7 %; P&lt;0.05), GRS (30.7±7.5 vs 32.9±4.5 and 41±3.9 % and EF (50±5 vs 52±3 and 56±3 %; P&lt;0.05 for CU, PU and NU respectively) (see figure 2). There were no significant differences between any group for LV torsion and GCS or RV EF and TAPSE.

Conclusions
3DE provides unique insight into bi-ventricular structure and function in RT athletes using AAS. The bi-ventricular enlargement seen in CU normalises when scaled to FFM and highlights a proportional increase in cardiac size to meet the metabolic requirements from elevated skeletal muscle mass. The reductions in LV GLS, GRS, GAS and EF without changes in RV function suggest a deleterious impact of AAS on LV but not RV function. The LV functional differences are also apparent in PU, and therefore, these findings suggest a possible permanent negative impact on LV function from AAS use. Further larger studies using 3DE in this population are warranted to further explore these findingsFigure 1 Figure 2