Laboratory of Experimental and Clinical Pharmacology, Faculty of Sciences, Section 1, Lebanese University, Rafic Hariri Educational Campus, Hadat, Lebanon; Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, University Medical Center Maastricht, Maastricht, the Netherlands.
Int J Cardiol. 2023 Jun 15;381:153-160. doi: 10.1016/j.ijcard.2023.03.057. Epub 2023 Mar 30.
Supra-physiologic doses of anabolic androgenic steroids (AAS) lead to multiple cardiovascular complications. The long-term clinical effect of AAS overuse on cardiac structure and function, which persists during off-cycle periods, remains unclear.
A total of 15 sedentary subjects and 79 bodybuilders (26 AAS non-users and 53 AAS-users), matched for age and male gender, were assessed in a cross-sectional design for echocardiography measures. AAS-users were included during an off-cycle phase, abstained from AAS for at least 1 month. 2D standard M-mode and speckle tracking echocardiography were used to measure cardiac dimensions and functions.
Inter-ventricular septum and posterior wall thickness were significantly higher among chronic off-cycle AAS-users compared to AAS non-users and sedentary group. Off-cycle AAS-users showed lower E/A ratio of the diastolic function. Left ventricular systolic function was not affected in terms of ejection fraction, but significant subclinical systolic dysfunction, assessed by GLS, was observed for chronic off-cycle AAS-users compared to AAS non-users (GLS = -16.8% vs. -18.5%, respectively; p = 0.001). Diameter of left atrium and right ventricle were significantly enlarged among off-cycle AAS-user bodybuilders (p = 0.002 and 0.040). TAPSE and RV S', and cardiac vasculature of aorta were comparable in all groups.
This study demonstrates that during off-cycle phase, AAS-users show long-term impaired GLS, even after considerable AAS abstain, despite normal LVEF. It highlights the importance of following GLS to predict hypertrophy and heart failure events, and not relying on LVEF alone. In addition, the hypertrophic effect of chronic AAS consumption is transitional during AAS washout periods.
超生理剂量的合成代谢雄激素类固醇（AAS）会导致多种心血管并发症。长期过度使用 AAS 对心脏结构和功能的临床影响，在停药期间仍然存在，目前尚不清楚。
本研究采用横断面设计，对 15 名久坐的受试者和 79 名健美运动员（26 名非 AAS 使用者和 53 名 AAS 使用者）进行了超声心动图检查。AAS 使用者在停药期间被纳入研究，且至少停用 AAS 1 个月。二维标准 M 模式和斑点追踪超声心动图用于测量心脏的维度和功能。
与非 AAS 使用者和久坐组相比，慢性停药期 AAS 使用者的室间隔和后壁厚度明显增加。停药期 AAS 使用者的舒张功能 E/A 比值较低。左心室射血分数的收缩功能未受影响，但慢性停药期 AAS 使用者的左心室整体纵向应变（GLS）显示出亚临床收缩功能障碍（GLS 分别为-16.8%和-18.5%；p=0.001）。停药期 AAS 使用者的左心房和右心室直径明显增大（p=0.002 和 0.040）。所有组的 TAPSE 和 RV S'以及主动脉的心脏血管均无差异。
本研究表明，在停药期间，AAS 使用者即使在相当长的 AAS 停药后，仍表现出长期的 GLS 受损，尽管左心室射血分数正常。这强调了跟踪 GLS 以预测心肌肥厚和心力衰竭事件的重要性，而不仅仅依赖于左心室射血分数。此外，慢性 AAS 消耗的肥大效应在 AAS 洗脱期间是过渡性的。
