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Cardiac effects of anabolic steroid use amongst recreational body builders - a CMR study
© Ismail et al; licensee BioMed Central Ltd. 2012
- Published: 1 February 2012
- Cardiovascular Magnetic Resonance
- Late Gadolinium Enhancement
- Hypertrophic Cardiomyopathy
- Anabolic Steroid
- Steroid User
Abuse of anabolic steroids to induce skeletal muscle hypertrophy is widespread amongst recreational bodybuilders, however, the cardiac effects of such drugs have not been systematically documented. The ability of cardiovascular magnetic resonance (CMR) to image the myocardium in any plane and achieve full myocardial coverage renders it the gold standard for assessing LV volumes and mass.We sought to investigate the cardiac effects of anabolic steroid use with CMR hypothesising that significant hypertrophy and distinct LV remodelling would be seen in steroid users relative to non-users.
A total of 23 recreational bodybuilders were studied - 15 anabolic steroid users and 8 non-users. CMR was undertaken on a 1.5T Avanto (Siemens, Erlangen, Germany) using breath-hold steady-state free precession cine sequences. Three long-axis images were obtained followed by sequential short axis cines from the AV-groove to the apex. Late gadolinium enhancement (LGE) imaging was performed ~10 min after intravenous Gadovist 0.1 mmol/kg (Schering, Berlin, Germany). Indexed LV and RV ventricular volumes, ejection fraction and indexed LV mass were determined using a semi-automated threshold-based algorithm after manual tracing of epicardial and endocardial borders (CMRtools, London, UK). LV remodelling index was calculated as the ratio of LV-mass to LV end-diastolic volume (LV-EDV).
Anabolic Steroid Users (mean±SD, n=15)
Non-users (mean±SD, n=8)
Body Surface Area (m 2 )
Indexed LV-EDV (g/m 2 )
Indexed LV-ESV (g/m 2 )
LV EF (%)
Indexed LV Mass (g/m 2 )
Maximum Wall Thickness (mm)
LV Remodeling Index (g/ml)
Indexed RV-EDV (g/m 2 )
Indexed RV-ESV (g/m 2 )
RV EF (%)
Anabolic steroid use amongst bodybuilders can induce significant left ventricular hypertrophy. The pattern and severity of remodelling can mimic hypertrophic cardiomyopathy. The use of such drugs should be considered in the differential diagnosis of significant otherwise unexplained left ventricular hypertrophy, particularly in the athletic cohort.
This work is supported by the NIHR Cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust, and Imperial College. Dr Ismail is supported by the British Heart Foundation.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.