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Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis.

  • D'Andrea, Antonello1, 2
  • Radmilovic, Juri2
  • Russo, Vincenzo1
  • Sperlongano, Simona1
  • Carbone, Andreina1
  • Di Maio, Marco3
  • Ilardi, Federica4
  • Riegler, Lucia2
  • D'Alto, Michele1
  • Giallauria, Francesco4
  • Bossone, Eduardo5
  • Picano, Eugenio6
  • 1 Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Via Bianchi 6, 80131, Italy. , (Italy)
  • 2 Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Viale S. Francesco 84014, Italy. , (France)
  • 3 Unit of Cardiology, "SS Addolorata" Hospital, Eboli (ASL Salerno), Piazza Scuola Medica Salernitana 84025, Italy. , (Italy)
  • 4 Cardiology and Internal Medicine, University of Naples Federico II, Naples, Via Pansini 5, 80131, Italy. , (Italy)
  • 5 UOC Cardiologia Riabilitativa, Cardarelli Hospital, Naples, Via Cardarelli 9, 80131, Italy. , (Italy)
  • 6 Institute of Clinical Physiology, CNR, Pisa, Via G. Moruzzi, Pisa 56121, Italy. , (Italy)
Published Article
European Journal of Preventive Cardiology
SAGE Publications
Publication Date
Feb 03, 2022
DOI: 10.1093/eurjpc/zwab086
PMID: 34339497


The real effects of the chronic consumption of anabolic-androgenic steroids (AASs) on cardiovascular structures are subjects of intense debate. The aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS. One hundred and fifteen top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. left atrial volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P < 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P < 0.01), pulmonary artery systolic pressure (beta = 0.43, P < 0.001) at peak effort and number of weeks of AAS use per year (beta = 0.45, P < 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P < 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data. In athletes abusing steroids, STE analysis showed an impaired RV systolic deformation, closely associated with reduced functional capacity during physical effort, and-during exercise-more pulmonary congestion. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]

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