S Marwaha, P Bulleros, Z Fanton, H Maclachlan, R Bhatia, G Finocchiaro, S Prasad, S Gati, M Papadakis, S Sharma. European Journal of Preventive Cardiology.
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Background
Consumption of recreational or performance enhancing agents can have long term adverse effects on the cardiovascular system, however, the effect of these agents on left ventricle size and the contractile reserve is unclear.
Method
145 male athletes with dilated left ventricle (LV) completed a confidential questionnaire enquiring about recreational and performance enhancing drug use and subsequently underwent a stress echocardiogram and cardiovascular magnetic resonance (CMR) imaging. Basal and peak left ventricular ejection function (LVEF) during stress echocardiography were used to determine. contractile reserve volumetric analysis on CMR imaging was used to determine LV size.
Results
44(30%) of athletes had acknowledged using recreational or performance enhancing drugs 12(8%) had used a form of anabolic drugs and 32 (22%) had used forms of non-anabolic drugs (such as cocaine, ecstasy and cannabis). Drug use was more commonly seen in gym/body building, 41.7% followed by 30.4% in runners, 28.5% in dual athletes, 28% in cyclists, 27.2% in rowers/skiers.
There were no significant differences in the mean indexed LV diastolic volumes between none-drug users, anabolic drug users and non-anabolic drug users(113.3ml/m2, 11.1ml/m2 and and 118ml/m2 respectively). Athletes who had taken anabolic steroids had a lower baseline LVEF compared to non-drug users with an of 52.5% and 56.59% and 56.5% respectively; p= 0.04.
Contractile reserve was significantly higher in anabolic users with an increase in mean LVEF from baseline to peak exercise of 22.7% compared with 16.1% in non-drug users and 14.4% in non-anabolic drug users (p value 0.034).
Conclusion
Recreational and performance drug use is relatively common amongst athletes. Anabolic drug use was associated with a baseline low LVEF but with high contractile reserve mimicking the situation of the true grey zone athlete (dilated LV with borderline LV function). We suspect initial increase in myocardial reserve reflects the Starling phenomenon of augmented stroke volume due to increased LV load, however, the long-term consequences of this phenomenon require further study.
