Uticaj zloupotrebe androgenih anaboličkih steroida i tipa treninga na remodelovanje i funkciju leve komore kod elitnih sportista

  • Ivan Ilić Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Vitomir Djordjević Health Center Dr. Ristić, Belgrade, Serbia
  • Ivan Stanković Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Alja Vlahović-Stipac Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Biljana Putniković Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Rade Babić Dedinje Cardiovascular Institute, Belgrade, Serbia
  • Aleksandar N. Nešković Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/3716
Ključne reči: athletes||, ||sportisti, substance-related disorders||, ||zloupotreba supstanci, androgens||, ||androgeni, ventricular remodeling||, ||srce, remodelovanje, risk assessment||, ||rizik, procena, echocardiography||, ||ehokardiografija,

Sažetak


Uvod/Cilj. Dugotrajni intenzivni trening povezan je sa adaptivnim promenama srčanog mišića poznatim kao sportsko srce. Cilj rada bio je da se utvrdi uticaj primene anaboličkih androgenih steroida (AAS) na ehokardiografske parametre morfologije i funkcije leve komore (LV) kod elitnih sportista koji se bave sportovima snage i izdržljivosti. Metode. Dvadeset elitnih sportista snage (10 korisnika AAS i 10 onih koji ne koriste AAS) upoređeni su sa 12 sportista izdržljivosti koji ne koriste AAS. Svi ispitanici bili su podvrgnuti standardnom ehokardiografskom pregledu sa tkivnim Dopler-om. Rezultati. Nakon indeksiranja prema telesnoj površini, leva pretkomora (LA) i end-dijastolni prečnik leve komore (LVEDD) bili su značajno veći kod sportista izdržljivosti nego kod sportista snage, bez obzira na uzimanje AAS (p < 0,05, za oba). Nađena je značajna korelacija između veličine LA i LVEDD kod sportista izdržljivosti koji ne uzimaju AAS, koja pokazuje da 75% varijablnosti veličine LA zavisi od varijabilnosti LVEDD (p < 0,001). Nije pokazana značajna razlika u ejekcionoj frakciji (EF) LV (LVEF) i minutnom volumenu između grupa, mada je blago snižena LVEF viđena samo kod sportista koji koriste AAS. Sportisti snage koji koriste AAS imali su veću vrednost pika A-talasa u poređenju sa sportistima koji ne koriste AAS, bez obzira na tip treninga (p < 0,05 za oba). Sportisti snage, bez obzira na primenu AAS, imali su niže vrednosti brzine e’ talasa i veći E/e’ odnos u poređenju sa sportistima izdržljivosti (p < 0,05 za sve). Zaključak. Nema dokaza da je primena AAS povezana sa promenom LVEF, bez obzira na tip treninga. Dugoročni trening izdržljivosti povezan je sa povoljnim efektima na dijastolnu funkciju LV u poređenju sa treningom snage, pogotovu ako je trening snage povezan sa zloupotrebom AAS.

Biografije autora

Ivan Ilić, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Clinical Hospital Center Zemun

Cardiac catheterization Lab

Vitomir Djordjević, Health Center Dr. Ristić, Belgrade, Serbia
attending cardiologist
Ivan Stanković, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Cardiology department, attending physician
Alja Vlahović-Stipac, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Cardiology department, Cardiac catheterization laboratory, attending physician
Biljana Putniković, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Cardiology department, Head
Rade Babić, Dedinje Cardiovascular Institute, Belgrade, Serbia
Cardiac catheterization laboratory, attending physician
Aleksandar N. Nešković, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Clinic for internal medicine, Head

Cardiac catheterization laboratory, Head

Reference

Fagard R. Athlete's heart. Heart 2003; 89(12): 1455−61.

Kutscher EC, Lund BC, Perry PJ. Anabolic steroids: a review for the clinician. Sports Med 2002; 32(5): 285−96.

Yesalis CE, Herrick RT, Buckley WE, Friedl KE, Brannon D, Wright JE. Self-reported use of anabolic-androgenic steroids by elite power lifters. Phys Sportmed 1988; 16(12): 91−100.

Tricker R, O'Neill MR, Cook D. The incidence of anabolic ste-roid use among competitive bodybuilders. J Drug Educ 1989; 19(4): 313−25.

Rocha FL, Carmo EC, Roque FR, Hashimoto NY, Rossoni LV, Frimm C, et al. Anabolic steroids induce cardiac renin-angiotensin system and impair the beneficial effects of aero-bic training in rats. Am J Physiol Heart Circ Physiol 2007; 293(6): 3575−83.

Ahlgrim C, Guglin M. Anabolics and cardiomyopathy in a bo-dybuilder: case report and literature review. J Card Fail 2009; 15(6): 496−500.

Hausmann R, Hammer S, Betz P. Performance enhancing drugs (doping agents) and sudden death: a case report and review of the literature. Int J Legal Med 1998; 111(5): 261−4.

Krieg A, Scharhag J, Kindermann W, Urhausen A. Cardiac tissue Doppler imaging in sports medicine. Sports Med 2007; 37(1): 15−30.

Hallynck TH, Soep HH, Thomis JA, Boelaert J, Daneels R, Dettli L. Should clearance be normalised to body surface or to lean body mass. Br J Clin Pharmacol 1981; 11(5): 523−6.

Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987; 317(17): 1098.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pel-likka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardio. J Am Soc Echo-cardiogr 2005; 18(12): 1440−63.

Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57(6): 450−8.

Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22(2): 107−33.

Vanberg P, Atar D. Androgenic anabolic steroid abuse and the cardiovascular system. Handb Exp Pharmacol 2010; 195: 411−57.

Payne JR, Kotwinski PJ, Montgomery HE. Cardiac effects of ana-bolic steroids. Heart 2004; 90(5): 473−5.

LeGros T, McConnell D, Murry T, Vettal ME, Racey-Burns LA, Shepherd RE, et al. The effects of 17.alpha.-methyltestosterone on myocardial function in vitro. Med Sci Sports Exerc 2000; 32(5): 897−903.

d'Andrea A , Caso P, Salerno G, Scarafile R, De CG, Mita C, et al. Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis. Br J Sports Med 2007; 41(3): 149−55.

Nottin S, Nguyen L, Terbah M, Obert P. Cardiovascular effects of androgenic anabolic steroids in male bodybuilders deter-mined by tissue Doppler imaging. Am J Cardiol 2006; 97(6): 912−5.

Krieg A, Scharhag J, Albers T, Kindermann W, Urhausen A. Car-diac tissue Doppler in steroid users. Int J Sports Med 2007; 28(8): 638−43.

de Piccoli B, Giada F, Benettin A, Sartori F, Piccolo E. Anabolic steroid use in body builders: an echocardiographic study of left ventricle morphology and function. Int J Sports Med 1991; 12(4): 408−12.

Yeater R, Reed C, Ullrich I, Morise A, Borsch M. Resistance trained athletes using or not using anabolic steroids com-pared to runners: effects on cardiorespiratory variables, body composition, and plasma lipids. Br J Sports Med 1996; 30(1): 11−4.

Thompson PD, Sadaniantz A, Cullinane EM, Bodziony KS, Catlin DH, Torek-Both G, et al. Left ventricular function is not im-paired in weight-lifters who use anabolic steroids. J Am Coll Cardiol 1992; 19(2): 278−82.

Palatini P, Giada F, Garavelli G, Sinisi F, Mario L, Michieletto M, et al. Cardiovascular effects of anabolic steroids in weight-trained subjects. J Clin Pharmacol 1996; 36(12): 1132−40.

Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik JA, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 2006; 47(12): 2357−63.

Pelliccia A, Maron BJ, Di PF, Biffi A, Quattrini FM, Pisicchio C, et al. Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol 2005; 46(4): 690−6.

Pelliccia A, Spataro A, Caselli G, Maron BJ. Absence of left ven-tricular wall thickening in athletes engaged in intense power training. Am J Cardiol 1993; 72(14): 1048−54.

Gyimes Z, Pavlik G, Simor T. Morphological and functional dif-ferences in cardiac parameters between power and endurance athletes: a magnetic resonance imaging study. Acta Physiol Hung 2004; 91(1): 49−57.

D'Andrea A, Caso P, Salerno G, Scarafile R, de Corato G, Mita C, et al. Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis. Br J Sports Med 2007; 41: 149−55.

Baggish AL, Weiner RB, Kanayama G, Hudson JI, Picard MH, Hutter AM, et al. Long-term anabolic-androgenic steroid use is associated with left ventricular dysfunction. Circ Heart Fail 2010; 3(4): 472−6.

Grace F, Sculthorpe N, Baker J, Davies B. Blood pressure and rate pressure product response in males using high-dose ana-bolic androgenic steroids (AAS). J Sci Med Sport 2003; 6(3): 307−12. Urhausen A, Albers T, Kindermann W. Are the cardiac effects of anabolic steroid abuse in strength athletes reversi-ble. Heart 2004; 90(5): 496−501.

Urhausen A, Albers T, Kindermann W. Are the cardiac effects of anabolic steroid abuse in strength athletes reversible. Heart 2004; 90(5): 496−501.

Objavljeno
2015/04/23
Broj časopisa
Vol. 71 Br. 4 (2014)
Rubrika
Originalni članak