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DOI: 10.1055/s-2004-817850
© Georg Thieme Verlag Stuttgart · New York
Left Ventricular Dimensions and Function in Strength Athletes
Re: Hartgens F, Cheriex EC, Kuipers H. Prospective Echocardiographic Assessment of Androgenic-anabolic Steroids Effects on Cardiac Structure and Function in Strength Athletes. Int J Sports Med 2003; 24: 344 - 351Publication History
Publication Date:
15 April 2004 (online)
There are indications that in strength athletes androgenic-anabolic steroids (AAS) cause detrimental effects on the cardiac structure and function [[2], [6], [7]], which confirms earlier studies on animals [[1]]. No conclusive data exist concerning the dosis and duration of AAS intake susceptible to induce these effects. The study by Hartgens et al. [[4]] presents the noteworthy finding that a short-term administration of AAS has no cardiovascular influence.
Unfortunately, the diastolic function was not examined in this study. A disturbed diastolic function of the left ventricle may be an early symptom of pathological hypertrophy and is helpful to differentiate between pathological and physiological myocardial hypertrophy. The diastolic function may be restricted in anabolic steroid users, which has been described by our working group [[7], [8], [9]] and others [[2], [5]], but it is true that the results are conflicting. The evaluation of diastolic function by measuring the transmitral blood flow profile by means of standard Doppler is possibly not sensitive enough. The assessment of regional myocardial velocities by means of tissue doppler velocity imaging (TVI) is apparently more sensitive. In a recent study we compared endurance athletes with bodybuilders using AAS and healthy controls [[9]]. The regional diastolic relaxation was significantly impaired in strength athletes abusing AAS in TVI, while the differences were not statistically significant by using the conventional transmitral Doppler. Further studies are necessary to resolve the question whether already short-term administration of AAS affects the cardiac function.
There is another issue that has to be mentioned. The interpretation of the baseline echocardiographic measurements is incomprehensible. The authors state that “In all subjects of both studies, the hearts showed enlargement of the left ventricle and left ventricle wall thickness” [[4]]. The baseline end-diastolic values (mean ± SD) for the wall thicknesses were between 8.0 ± 0.9 and 8.9 ± 0.9 mm. Considering the double standard deviation, most of the examined strength athletes have rather thin walls. Only a few subjects have wall thicknesses of more than 11 mm. Similarly, neither the left ventricular end-diastolic diameter nor the left ventricular mass (LVM) indicate an enlarged left ventricle if the body dimensions are taken into consideration. Apart from that, the authors do unfortunately not cite the echocardiographic method determining LVM.
Altogether, the measurements of the left ventricle adjusted to the body dimensions are normal, no cardiac enlargement is demonstrable. This corresponds with the expectations because strength training has no influence on cardiac morphology. Cardiac cavity dimensions in particular are not increased in strength-trained individuals [[3], [8], [9], [10], [11]]. Although the author's interpretation of their echocardiographic measurements is not conclusive, the final statement is correct that the subjects were considered to have normal echocardiographic findings.