Comparison of Left Atrial Function in Long-Term Anabolic/Androgenic Steroid Users versus Nonuser Bodybuilders by Using Two-Dimensional Speckle-Tracking Echocardiography
Keywords: Anabolic/androgenic steroid, bodybuilder athletes, left atrial function, speckle tracking, left atrial strain
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.