Available online 29 July 2022

Athletes who use steroids or are diagnosed with CMH have LV regional dysfunctions.

The anabolic steroids used by athletes induce a drop in myocardial work efficiency.

Regional myocardial work analysis differentiates between steroid use and CMH in athletes.

Strength-trained athletes using anabolic androgenic steroids (AAS) have left ventricular (LV) hypertrophy and myocardial fibrosis that can lead to sudden cardiac death. A similar feature was described in athletes with hypertrophic cardiomyopathy (HCM), which complicates the diagnosis for clinicians. In this context, we aimed to compare the left ventricular function of the two populations by measuring global and regional strain and myocardial work using speckle-tracking imaging.

Twenty-four strength-trained asymptomatic athletes using AAS (AAS-Athletes), 22 athletes diagnosed with HCM (HCM-Athletes), and 20 healthy control athletes (Ctrl-Athletes) underwent a resting echocardiography to assess LV function. We evaluated LV global and regional strains and myocardial work, with an evaluation of the constructive work (CW), wasted work (WW), and work efficiency (WE).

Compared to Ctrl-Athletes, both AAS-Athletes and HCM-Athletes had a thicker interventricular septum, with majored values in HCM-Athletes. LV strain was reduced in AAS-athletes and even more in HCM-Athletes. Consequently, global WE was significantly diminished in both AAS and HCM-Athletes (93 ± 2% in Ctrl-Athletes, 90 ± 4% in AAS-Athletes, and 90 ± 5% in HCM-Athletes, p<0.05). CW and WE regional analysis showed specific alterations, with the basal septal segments preferentially affected in AAS-Athletes, and both septal and apical segments affected in HCM-Athletes.

The regional evaluation of myocardial work reported specific alterations of the major LV hypertrophy induced by the regular use of AAS compared to the LV hypertrophy due to HCM. This finding could help clinicians to differentiate between these two forms of pathological hypertrophies.

Anabolic androgenic steroids

Hypertrophic cardiomyopathy

Left ventricular function

Myocardial work

Speckle-tracking echocardiography

© 2022 Published by Elsevier B.V. on behalf of Shanghai University of Sport.