Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Departamento de Farmacociências da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
Int J Sports Med. 2022 Feb;43(2):183-191. doi: 10.1055/a-1518-7953. Epub 2021 Aug 2.
Anabolic androgenic steroid (AAS) abuse leads to myocardial toxicity. Human studies are conflicting about the myocardial fibrosis in AAS users. We evaluated cardiac tissue characterization, left ventricle (LV) function, and cardiac structure by cardiovascular magnetic resonance (CMR). Twenty strength-trained AAS users (AASU) aged 29±5 yr, 20 strength-trained AAS nonusers (AASNU), and 7 sedentary controls (SC) were enrolled. Native T1 mapping, late-gadolinium enhancement (LGE), extracellular volume (ECV), and myocardial strain were evaluated. AASU showed lower Native T1 values than AASNU (888±162 vs. 1020±179 ms p=0.047). Focal myocardial fibrosis was found in 2 AASU. AASU showed lower LV radial strain (30±8 vs. 38±6%, p<0.01), LV circumferential strain (-17±3 vs. -20±2%, p<0.01), and LV global longitudinal strain (-17±3 vs. -20±3%, p<0.01) than AASNU by CMR. By echocardiography, AASU demonstrated lower 4-chamber longitudinal strain than AASNU (-15±g3 vs. -18±2%, p=0.03). ECV was similar among AASU, AASNU, and SC (28±10 vs. 28±7 vs. 30±7%, p=0.93). AASU had higher LV mass index than AASNU and SC (85±14 vs. 64±8 vs. 58±5 g/m, respectively, p<0.01). AAS abuse may be linked to decreased myocardial native T1 values, impaired myocardial contractility, and focal fibrosis. These alterations may be associated with maladaptive cardiac hypertrophy in young AAS users.
合成代谢雄激素类固醇（AAS）滥用可导致心肌毒性。关于 AAS 使用者的心肌纤维化，人体研究结果存在矛盾。我们通过心血管磁共振（CMR）评估心脏组织特征、左心室（LV）功能和心脏结构。共纳入 20 名年龄为 29±5 岁的力量训练 AAS 使用者（AASU）、20 名力量训练 AAS 非使用者（AASNU）和 7 名久坐不动的对照组（SC）。评估了心肌的固有 T1 映射、晚期钆增强（LGE）、细胞外容积（ECV）和心肌应变。与 AASNU 相比，AASU 的固有 T1 值较低（888±162 对 1020±179ms，p=0.047）。在 2 名 AASU 中发现了局灶性心肌纤维化。与 AASNU 相比，AASU 的 LV 径向应变（30±8 对 38±6%，p<0.01）、LV 环向应变（-17±3 对-20±2%，p<0.01）和 LV 整体纵向应变（-17±3 对-20±3%，p<0.01）较低。通过超声心动图，AASU 的 4 腔室纵向应变低于 AASNU（-15±g3 对-18±2%，p=0.03）。AASU、AASNU 和 SC 之间的 ECV 相似（28±10 对 28±7 对 30±7%，p=0.93）。与 AASNU 和 SC 相比，AASU 的 LV 质量指数更高（分别为 85±14 对 64±8 对 58±5g/m，p<0.01）。AAS 滥用可能与心肌固有 T1 值降低、心肌收缩功能受损和局灶性纤维化有关。这些改变可能与年轻 AAS 使用者的适应性心脏肥大有关。
