Comparison of Left Atrial Function in Long-Term Anabolic/Androgenic Steroid Users versus Nonuser Bodybuilders by Using Two-Dimensional Speckle-Tracking Echocardiography

Year 2017, Volume: 20 Issue: 3, 185 - 194, 03.12.2017

Elnur Alizade

Abstract

Introduction:
Long-term
illicit use of supraphysiological doses of anabolic/androgenic steroids (AAS)
may cause pathological left ventricular hypertrophy (LVH), diastolic
dysfunction, left atrial (LA) hypertrophy, increased myocardial stiffness, and
myocardial fibrosis. Therefore, distinguishing AAS-using athlete’s hearts from
the nonpathological “athlete’s heart” is critically important. The aim of this
study was to evaluate LA myocardial function using 2D-STE method in both
AAS-using and drug-free bodybuilders, and assess its potential role in the
differential diagnosis between these two entities.

Patients
and Methods: We selected a population of 33 male, competitive bodybuilders,
including 15 actively using AAS for > 2 years (users) and 18 who had never
used AAS (nonusers).

Results: AAS users
had a significantly lower global LA strain reservoir (GLAS-R), global LA strain
during early diastole (GLAS-E; 38.2 ± 8.4 vs. 48.6 ± 11.9, p< 0.01; 24.4 ±
8.6 vs. 37.1 ± 12.8, p< 0.01; respectively), global LA strain rate reservoir
(GLASR-R), global LA strain rate during early diastole (GLASR-E; 1.8 ± 0.3 vs.
2.2 ± 0.4, p< 0.01; -1.4 ± 0.2 vs. -1.8 ± 0.3, p< 0.01; respectively)
than nonusers. The univariate correlation analysis demonstrated that GLAS-R,
GLAS-E, GLASR-R, and GLASR-E had a good inverse correlation with E/Em (r:
-0.34, p= 0.04; r: -0.35, p= 0.04; r: -0.35, p= 0.04, and r: -0.35, p= 0.04,
respectively).

Conclusion: The present study confirms
that LA strain and strain rate are impaired in AAS users compared to nonusers
and provide valuable additional information to that obtained by conventional
echocardiography in the differential diagnosis between pathological and physiological
LVH.

Keywords

Anabolic/androgenic steroid, bodybuilder athletes, left atrial function, speckle tracking, left atrial strain

Uzun Dönem Anabolik-Androjenik Steriod Kullanan ve Kullanmayan Vücut Geliştiricilerde Sol Atrial Fonksiyonların İki Boyutlu Benekli İşaretleme Ekokardiyografik Yöntemi ile Karşılaştırılması

Abstract

Giriş: Uzun dönem ve yüksek dozda anabolik-androjenik steriod (AAS) kullanımı sol
ventirkül patalojik hipertrofisine (SVH), diyastolik disfonksiyona, sol atrium
(SA) hipertrofisine, miyokart sertlik ve fibrozisinde artmaya neden olur.
Bundan dolayı AAS kullanan sporcuların patolojik olmayan “sporcu kalbi”inden
ayrımı kritik öneme sahiptir. Bu çalışmanın amacı SA miyokart fonksiyonlarının
iki boyutlu benekli ekokardiyografik yöntem ile AAS kullanan ve kullanmayan
vücut geliştiricilerde değerlendirilmesi ve bu yöntemin bu iki durumun
ayrımında kullanılmasıdır.

Hastalar ve
Yöntem: Çalışmamıza 15’i aktif olarak AAS kullanan (> 2 yıl)
ve 18’i hiç AAS kullanmayan hepsi erkek olan toplam 33 yarışımcı vücut
geliştirici alındı.

Bulgular: AAS kullanan atletlerin global SA strain reservoir (GLAS-R), global SA
erken diyastol strain (GLAS-E) (38.2 ± 8.4 vs. 48.6 ± 11.9, p< 0.01; 24.4 ±
8.6 vs. 37.1 ± 12.8, p< 0.01; sırasıyla), global SA strain rate reservoir
(GLASR-R), global SA erken diyastol strain rate (GLAS-E) (1.8 ± 0.3 vs. 2.2 ±
0.4, p< 0.01; -1.4 ± 0.2 vs. -1.8 ± 0.3, p< 0.01; sırasıyla) değerlerinin
kullanmayan sporculara göre önemli ölçüde azaldığı görüldü. Univaryant
korelasyon analizi GLAS-R, GLAS-E, GLASR-R ve GLASR-E değerlerinin E/Em (r:
-0.34, p = 0.04; r: -0.35, p= 0.04; r: -0.35, p= 0.04 and r: -0.35, p= 0.04,
sırasıyla) ile ters korelasyon olduğunu gösterdi.

Sonuç: Bu çalışma SA strain ve
strain rate değerlerinin AAS kullanan sporcularda kullanmayan sporculara göre
azaldığı, ayrıca patolojik ve fizyolojik SVH ayırıcı tanısında konvansiyonel
ekokardiyografi ile elde edilen bulgulara ek değerli bilgiler sağladığı
doğrulanmıştır.

Keywords

Anabolik-androjenik steroid, vücut geliştirici sporcular, sol atrial fonksiyon, benekli işaretleme, sol atrial strain

References

• 1. Kanayama G, Hudson JI, Pope HG Jr. Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend 2008;98:1-12.
• 2. Parssinen M, Seppala T. Steroid use and long-term health risks in former athletes. Sports Med 2002;32:83-94.
• 3. Thiblin I, Petersson A. Pharmacoepidemiology of anabolic androgenic steroids: a review. Fundam Clin Pharmacol 2005;19:27-44.
• 4. Paul Vanberg, Dan Atar. Androgenic anabolics steroid abuse and the cardiovascular system. Handb Exp Pharmacol 2010;411-57.
• 5. Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. Am J Cardiol 2010;106:893-901.
• 6. 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 weightlifters. Eur Heart J 1996;17:1576-83.
• 7. 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;41:149-55.
• 8. 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;97:912-5.
• 9. Krieg A, Scharhag J, Albers T, Kindermann W, Urhausen A. Cardiac tissue Doppler in steroid users. Int J Sports Med 2007;28:638-43.
• 10. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 2006;47:2357-63.
• 11. Sauter HJ, Dodge HT, Johnston RR, Graham TP. The relationship of left atrial pressure and volume in patients with heart disease. Am Heart J 1964;67:635-42.
• 12. Matsuda Y, Toma Y, Ogawa H, Matsuzaki M, Katayama K, Fujii T, et al. Importance of left atrial function in patients with myocardial infarction. Circulation 1983;67:566-71.
• 13. D’Andrea A, De Corato G, Scarafile R, Romano S, Reigler L, Mita C, et al: Left atrial myocardial function in either physiological or pathological left ventricular hypertrophy: A two-dimensional speckle strain study. Br J Sports Med 2008;42:696-702.
• 14. Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, et al. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 2009;8:6.
• 15. Altekin RE, Yanikoglu A, Karakas MS, Ozel D, Kucuk M, Yilmaz H, et al. Assessment of left atrial dysfunction in obstructive sleep apnea patients with the two dimensional speckle-tracking echocardiography. Clin Res Cardiol 2012;101:403-13.
• 16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14.
• 17. 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;22:107-33.
• 18. Peterson LR, Waggoner AD, Schechtman KB, Meyer T, Gropler RJ, Barzilai B, et al. Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging. J Am Coll Cardiol 2004;43:1399-404.
• 19. Kircher B, Abbott JA, Pau S, Gould RG, Himelman RB, Higgins CB, et al. Left atrial volume determination by biplane two dimensional echocardiography: validation by cine computed tomography. Am Heart J 1991;121:864-71.
• 20. Paraskevaidis I, Doduras T, Adamopoulos S, Kremastinos DT. Left atrial functional reserve in patients with nonischaemic dilated cardiomyopathy: an echocardiographic dobutamine study. Chest 2002;122:1340-7.
• 21. Moyssakis I, Papadopoulos DP, Kelepeshis G, Gialafos E, Votteas V, Triposkiadis F. Left atrial systolic reserve in idiopathic vs. ischaemic-dilated cardiomyopathy. Eur J Clin Invest 2005;35:355-61.
• 22. Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP. Two-dimensional speckle-tracking echocardiographyof the left atrium: feasibility and regional contractionand relaxation differences in normal subjects. J Am Soc Echocardiogr 2009;22:299-305.
• 23. Kim DG, Lee KJ, Lee S, Jeong SY, Lee YS, Choi YJ, et al Feasibility of two-dimensional global longitudinal strain and strain rate imaging for the assessment of left atrial function: a study in subjects with a low probability of cardiovascular disease and normal exercise capacity. Echocardiography 2009;26:1179-87.
• 24. 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;86:177-84.
• 25. Pelliccia A, Culasso F, Di Paolo F, Maron BJ. Physiologic left ventricular cavity dilation in elite athletes. Ann Intern Med 1999;130:23-31.
• 26. Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE. The athlete’s heart. A metaanalysis of cardiac structure and function. Circulation 2000;101:336-42.
• 27. Richand V, Lafitte S, Reant P, Serri K, Lafitte M, Brette S, et al. An ultrasound speckle tracking (two-dimensional strain) analysis of myocardial deformation in professional soccer players compared with healthy subjects and hypertrophic cardiomyopathy. Am J Cardiol 2007;100:128-32.
• 28. Gabrielli L, Enríquez A, Córdova S, Yáñez F, Godoy I, Corbalán R. Assessment of left atrial function in hypertrophic cardiomyopathy and athlete’s heart: a left atrial myocardial deformation study. Echocardiography 2012;29:943-9.
• 29. De Marchi SF, Allemann Y, Seiler C. Relaxation in hypertrophic cardiomyopathy and hypertensive heart disease: Relations between hypertrophy and diastolic function. Heart 2000;83:678-84.
• 30. Scharhag J, Schneider G, Urhausen A, Rochette V, Kramann B, Kindermann W. Athlete’s heart: Right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. J Am Coll Cardiol 2002;40:1856-63.
• 31. Schmidt-Trucksäss A, Schmid A, Häussler C, Huber M, Huonker M, Keul J. Left ventricular wall motion during diastolic filling in endurancetrained athletes. Med Sci Sports Exerc 2001;33:189-95.
• 32. Pearson AC, Schiff M, Mrosek D, Labovitz AJ, Williams GA. Left ventricular diastolic function in weight lifters. Am J Cardiol 1986;58: 1254-9.
• 33. Urhausen A, Holpes R, Kindermann W. One- and two-dimensional echocardiography in bodybuilders using anabolic steroids. Eur J Appl Physiol Occup Physiol 1989;58:633-40.
• 34. Urhausen A, Albers T, Kindermann W. Are the cardiac effects of anabolic steroid abuse in strength athletes reversible? Heart 2004;90:496-501.
• 35. 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;30:760-8.
• 36. 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;36:891-6.
• 37. To AC, Flamm SD, Marwick TH, Klein AL. Clinical utility of multimodality LA imaging: assessment of size, function, and structure. JACC Cardiovasc Imag 2011;4:788-98.
• 38. Cianciulli TF, Saccheri MC, Lax JA, Bermann AM, Ferreiro DE. Two-dimensional speckle tracking echocardiography for the assessment of atrial function. World J Cardiol 2010;2:163-70.
• 39. Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popović ZB, Thomas JD, et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 2010;23:172-180.
• 40. Sun P, Wang ZB, Li JX, Nie J, Li Y, He XQ, et al; Evaluation of left atrial function in physiological and pathological left ventricular myocardial hypertrophy by real-time tri-plane strain rate imaging. Clin Cardiol 2009;32:676-83.
• 41. Alizade E, Avcı A, Fidan S, Tabakçı M, Bulut M, Zehir R, et al. The Effect of chronic anabolic-androgenic steroid use on Tp-E interval, Tp-E/Qt Ratio, and Tp-E/Qtc Ratio in Male Bodybuilders. Ann Noninvasive Electrocardiol 2015;20:592-600.
• 42. Ogawa K, Hozumi T, Sugioka K, Iwata S, Otsuka R, Takagi Y, et al. Automated assessment of left atrial function from time-left atrial volume curves using a novel speckle tracking imaging method. J Am Soc Echocardiogr 2009;22:63-9.
• 43. Otani K, Takeuchi M, Kaku K, Haruki N, Yoshitani H, Tamura M, et al. Impact of diastolic dysfunction grade on left atrial mechanics assessed by two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr 2010;23:961-7.
• 44. Montisci M, El Mazloum R, Cecchetto G, Terranova C, Ferrara SD, Thiene G, et al. Anabolic androgenic steroids abuse and cardiac death in athletes: morphological and toxicological findings in four fatal cases. Forensic Sci Int 2012;217:e13-8 (21).
• 45. Fineschi V. Chronic, supra-physiological doses of nandrolone decanoate and exercise induced cardio-toxicity in an animal-model study. Acta Physiol (Oxf) 2013;208:141-3.
• 46. Montisci R, Cecchetto G, Ruscazio M, Snenghi R, Portale A, Viel G, et al. Early myocardial dysfunction after chronic use of anabolic androgenic steroids combined pulse-wave-tissue doppler imaging and ultrosonic integrated backscatter cyclic variations analaysis. J Am Soc Echocardiogr 2010;23:516-22.
• 47. Morris DA, Gailani M, Vaz Pérez A, Blaschke F, Dietz R, Haverkamp W, et al. Left atrial systolic and diastolic dysfunction in heart failure with normal left ventricular ejection fraction. J Am Soc Echocardiogr 2011;24:651-62.
• 48. Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, et al. Left atrial strain and strain rate in patients with paroxysmaland persistent atrial fibrillation. Relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 2010;3:231-9.
• 49. Ohtani K, Yutani C, Nagata S, Koretsune Y, Hori M, Kamada T. High prevalence of atrial fibrosis in patients with dilated cardiomyopathy. J Am Coll Cardiol 1995;25:1162-9.
• 50. Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 2006;47:789-93.