Anabolic androgenic steroid use is associated with ventricular dysfunction on cardiac MRI in strength trained athletes

Abstract Background Uncertainty remains about possible cardiac adaptation to resistance training. Androgenic anabolic steroids (AAS) use plays a potential role and may have adverse cardiovascular effects. Objective To elucidate the effect of resistance training and of AAS-use on cardiac dimensions and function. Participants Cardiac magnetic resonance (CMR) were performed in 156 male subjects aged 18–40 years: 52 non-athletes (maximum of 3 exercise hours/week), 52 strength–endurance (high dynamic–high static, HD–HS) athletes and 52 strength (low dynamic–high static, LD–HS) trained athletes (athletes ≥ 6 exercise hours/week). 28 LD–HS athletes denied and 24 admitted to AAS use for an average duration of 5 years (range 3 months–20 years). Results No significant differences were found between non-athletes and non-AAS-using LD–HS athletes. AAS-using LD–HS athletes had significantly larger LV and RV volumes and LV wall mass than non-AAS-using LD–HS athletes, but lower than HD–HS athletes. In comparison to all other groups AAS-using LD–HS athletes showed lower ejection fractions of both ventricles (LV/RV EF 51/48% versus 55–57/51–52%) and lower E/A ratios (LV/RV 1.5/1.2 versus 1.9–2.0/1.4–1.5) as an indirect measure of diastolic function. Linear regression models demonstrated a significant effect of AAS-use on LV EDV, LV EDM, systolic function and mitral valve E/A ratio (all ANOVA-tests p < 0.05). Conclusions Strength athletes who use AAS show significantly different cardiac dimensions and biventricular systolic dysfunction and impaired ventricular inflow as compared to non-athletes and non-AAS-using strength athletes. Increased ventricular volume and mass did not exceed that of strength–endurance athletes. These findings may help raise awareness of the consequences of AAS use.