Left ventricular diastolic function in weight lifters

Cardiac structure and function in resistance-trained and untrained adults: A systematic review and meta-analysis

Variations in the haemodynamic demands of specific training modalities may explain characteristic differences in cardiac structure and function amongst athletes. However, current consensus regarding these adaptations in highly resistance-trained athletes is yet to be established. The current invetsigation aimed to collate research investigating cardiac structure and function in resistance-trained athletes, exploring the defining characteristics of Athlete's Heart within these individuals. Seven electronic databases were searched. Studies which examined at least one measure of cardiac structure or function, included healthy, normotensive male or females (>18 years) and compared athletes engaged in a resistance training programme (>12 months) to an untrained group engaged in no structured training programme were included. Systematic selection and quality appraisal of articles was performed by two reviewers, with a random effects meta-analysis model applied to suitable studies. Studies were limited to orginal peer-reviewed articles published in English. Resistance-trained athletes (n = 949) demonstrated greater cardiac dimensions compared to their untrained counterparts (n = 1053). No clear impairments to systolic or diastolic cardiac function were observed in athletic population studied here. Resistance-trained athletes display some characteristics of the Athlete's Heart phenomenon, including greater wall thickening and chamber dilation compared to their untrained counterparts.

Distinct skeletal stem cell types orchestrate long bone skeletogenesis

Skeletal stem and progenitor cell populations are crucial for bone physiology. Characterization of these cell types remains restricted to heterogenous bulk populations with limited information on whether they are unique or overlap with previously characterized cell types. Here we show, through comprehensive functional and single-cell transcriptomic analyses, that postnatal long bones of mice contain at least two types of bone progenitors with bona fide skeletal stem cell (SSC) characteristics. An early osteochondral SSC (ocSSC) facilitates long bone growth and repair, while a second type, a perivascular SSC (pvSSC), co-emerges with long bone marrow and contributes to shape the hematopoietic stem cell niche and regenerative demand. We establish that pvSSCs, but not ocSSCs, are the origin of bone marrow adipose tissue. Lastly, we also provide insight into residual SSC heterogeneity as well as potential crosstalk between the two spatially distinct cell populations. These findings comprehensively address previously unappreciated shortcomings of SSC research.

Skeletal Stem Cells as the Developmental Origin of Cellular Niches for Hematopoietic Stem and Progenitor Cells

The skeletal system is a highly complex network of mesenchymal, hematopoietic, and vasculogenic stem cell lineages that coordinate the development and maintenance of defined microenvironments, so-called niches. Technological advancements in recent years have allowed for the dissection of crucial cell types as well as their autocrine and paracrine signals that regulate these niches during development, homeostasis, regeneration, and disease. Ingress of blood vessels and bone marrow hematopoiesis are initiated by skeletal stem cells (SSCs) and their more committed downstream lineage cell types that direct shape and form of skeletal elements. In this chapter, we focus on the role of SSCs as the developmental origin of niches for hematopoietic stem and progenitor cells. We discuss latest updates in the definition of SSCs, cellular processes establishing and maintaining niches, as well as alterations of stem cell microenvironments promoting malignancies. We conclude with an outlook on future studies that could take advantage of SSC-niche engineering as a basis for the development of new therapeutic tools to not only treat bone-related diseases but also maladies stemming from derailed niche dynamics altering hematopoietic output.

Echocardiographic and biomarker evidence of plasma volume expansion after short-term steroids administered orally in cats

Background

Steroids administered PO and intramuscularly are associated with development of congestive heart failure in cats without prior signs of heart disease, but criteria to identify cats at increased risk for steroid‐induced heart failure are not established.

Hypothesis

Cats administered steroids PO for 5 to 7 days will develop increased N terminal pro‐B‐type natriuretic peptide (NT‐proBNP) concentration and heart size.

Animals

Ten client‐owned cats.

Methods

Observational cohort study. Cats intended to initiate at least a 5‐day course of steroids administered PO were consecutively recruited.

Results

Steroids administered PO to cats are not associated with differences in absolute concentration of NT‐proBNP (baseline: 49 pmol/L [range, 24‐1013]; after steroids: 85 pmol/L [range, 46‐1367]; P = .23), blood pressure (baseline: 145 mm Hg [range, 116‐163]; after steroids: 145 mm Hg [range, 115‐230]; P = .94), nor blood glucose concentration (baseline: 125 mg/dL [range, 92‐254]; after steroids: 144 mg/dL [range, 114‐307]; P = .43), but are associated with increased median left atrial dimension (baseline: 1.26 cm [range, 0.96‐2.03; after steroids: 1.38 [range, 1.03‐2.20]; P = .02) and mean left ventricular internal diameter (baseline: 1.55 cm [standard deviation—SD, 0.28; after steroids: 1.72 cm [SD, 0.28]; P = .03). Six of 10 (60%) cats had a percentile change in NT‐proBNP >60% after steroids, and 3 of 8 (38%) cats with baseline BNP <100 pmol/L had an NT‐proBNP >100 pmol/L after steroids.

Conclusions and Clinical Importance

Increased heart size and percentage change in individual NT‐proBNP concentration suggests plasma volume expansion secondary to steroids administered PO in cats. A serial assessment of an individual cat's change in NT‐proBNP might be clinically useful for judging risk for volume expansion.

A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse

Drugs of abuse are associated with stroke, especially in young individuals. The major classes of drugs linked to stroke are cocaine, amphetamines, heroin, morphine, cannabis, and new synthetic cannabinoids, along with androgenic anabolic steroids (AASs). Both ischemic and hemorrhagic stroke have been reported due to drug abuse. Several common mechanisms have been identified, such as arrhythmias and cardioembolism, hypoxia, vascular toxicity, vascular spasm and effects on the thrombotic mechanism, as causes for ischemic stroke. For hemorrhagic stroke, acute hypertension, aneurysm formation/rupture and angiitis-like changes have been implicated. In AAS abuse, the effect of blood pressure is rather substance specific, whereas increased erythropoiesis usually leads to thromboembolism. Transient vasospasm, caused by synthetic cannabinoids, could lead to ischemic stroke. Opiates often cause infective endocarditis, resulting in ischemic stroke and hypereosinophilia accompanied by pyogenic arthritis, provoking hemorrhagic stroke. Genetic variants are linked to increased risk for stroke in cocaine abuse. The fact that case reports on cannabis-induced stroke usually refer to the young population is very alarming.

Systolic and Diastolic Left Ventricular Mechanics during and after Resistance Exercise

PURPOSE

To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist, and untwisting rate ("LV mechanics").

METHODS

LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7-12 s) double-leg press exercise at two intensities (30% and 60% of maximum strength, one-repetition maximum). Speckle tracking analysis generated LV strain, twist, and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated.

RESULTS

Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased, whereas SVR and LV wall stress increased (P < 0.05). Immediately after effort, stroke volume returned to baseline, whereas SVR and wall stress decreased (P < 0.05). Similarly, acute exercise was accompanied by a significant decrease in systolic parameters of LV muscle mechanics (P < 0.05). However, diastolic parameters, including LV untwisting rate, were statistically unaltered (P > 0.05). Immediately after exercise, systolic LV mechanics returned to baseline levels (P < 0.05) but LV untwisting rate increased significantly (P < 0.05).

CONCLUSIONS

A single, acute bout of double-leg press resistance exercise transiently reduces systolic LV mechanics, but increases diastolic mechanics after exercise, suggesting that resistance exercise has a differential impact on systolic and diastolic heart muscle function. The findings may explain why acute resistance exercise has been associated with reduced stroke volume but chronic exercise training may result in increased LV volumes.

The Effect of Chronic Anabolic-Androgenic Steroid Use on Tp-E Interval, Tp-E/Qt Ratio, and Tp-E/Qtc Ratio in Male Bodybuilders

BACKGROUND

The chronic consumption of androgenic anabolic steroids has shown to cause atrial arrhythmias. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate repolarization dispersion measured from the 12-lead surface electrocardiogram (including Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio) in bodybuilders who are using anabolic androgenic steroids (AAS).

METHODS

We selected a population of 33 competitive bodybuilders, including 15 actively using AAS for ≥ 2 years (users) and 18 who had never used AAS (nonusers), all men.

RESULTS

QT, cQT, QTd, cQTd, JT, and cJT were significantly increased in AAS users bodybulders compared to the nonusers (all P < 0.001). Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio were also significantly higher in AAS user group compared to the nonuser group (all P < 0.001). QRS duration was not different between the groups. There were negative correlation between E(m) and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = -0.657, P < 0.01; r = -0.607, P = 0.02; r = -0.583, P = 0.02; respectively).There were also negative correlation between S(m) and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = -0.681, P < 0.01; r = -0.549, P = 0.03; r = -0.544, P = 0.023; respectively).

CONCLUSION

In conclusion, we have presented a strong evidence suggesting that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were increased in AAS users, which suggest that there might be a link between AAS use and ventricular arrthymias and sudden death.

Long-term anabolic androgenic steroid use is associated with increased atrial electromechanical delay in male bodybuilders

We investigated the effect of long-term supraphysiologic doses of anabolic androgenic steroids (AAS) on atrial electromechanical delay (AEMD) in male bodybuilders. We clearly demonstrated that long-term consumption of supraphysiologic doses of AAS is associated with higher values of inter- and intra-AEMD in healthy young bodybuilders.

Administration of an anabolic steroid during the adolescent phase changes the behavior, cardiac autonomic balance and fluid intake in male adult rats

Few data are available on adolescent users because most behavioral studies on anabolic-androgenic steroids (AAS) abuse have been performed in adults. Studies evaluating the impact of long-term effects of AAS abuse on the prepubertal phase are even more uncommon. Accordingly, this study was developed to test the hypothesis that changes induced by the use of AAS during the adolescent phase may be noted in the adult phase even when the AAS treatment cycle is discontinued. Therefore, not only behavioral changes but also possible autonomic and electrolyte disorders were evaluated. For this purpose, we used male prepubertal, 26-day-old (P26) Wistar rats that were treated with vehicle (control, n=10) or testosterone propionate (TP; 5 mg/kg intramuscular (IM) injection, AAS, n=10) five times per week for 5 weeks, totaling 25 applications during the treatment. Aggression tests were performed at the end of the cycle (P54-56), whereas open-field tests (OFTs), elevated plus maze (EPM) behavioral tests and measurements of heart rate variability (HRV), fluid intake and pathology were conducted in the adult phase (P87-92). The AAS group showed greater aggressiveness in the pubertal phase and higher levels of horizontal and vertical exploration and anxiety-related behavior in the adult phase than the control group (P<0.05). HRV tests showed an increase in sympathetic autonomic modulation, and hydroelectrolytic assessment showed lower basal intake levels of hypertonic saline than the control group (P<0.05), without statistically significant changes in the basal intake of water. These data together suggest that the use of AAS during the prepubertal phase induces behavioral, autonomic and hydroelectrolytic changes that manifest in the adult phase even when treatment is discontinued in late adolescence in rats.

Unique aspects of competitive weightlifting: performance, training and physiology

Weightlifting is a dynamic strength and power sport in which two, multijoint, whole-body lifts are performed in competition; the snatch and clean and jerk. During the performance of these lifts, weightlifters have achieved some of the highest absolute and relative peak power outputs reported in the literature. The training structure of competitive weightlifters is characterized by the frequent use of high-intensity resistance exercise movements. Varied coaching and training philosophies currently exist around the world and further research is required to substantiate the best type of training programme for male and female weightlifters of various age groups. As competitive weightlifting is contested over eight male and seven female body weight categories, the anthropometric characteristics of the athletes widely ranges. The body compositions of weightlifters are similar to that of athletes of comparable body mass in other strength and power sports. However, the shorter height and limb lengths of weightlifters provide mechanical advantages when lifting heavy loads by reducing the mechanical torque and the vertical distance that the barbell must be displaced. Furthermore, the shorter body dimensions coincide with a greater mean skeletal muscle cross-sectional area that is advantageous to weightlifting performance. Weightlifting training induces a high metabolic cost. Although dietary records demonstrate that weightlifters typically meet their required daily energy intake, weightlifters have been shown to over consume protein and fat at the expense of adequate carbohydrate. The resulting macronutrient imbalance may not yield optimal performance gains. Cross-sectional data suggest that weightlifting training induces type IIX to IIA fibre-type transformation. Furthermore, weightlifters exhibit hypertrophy of type II fibres that is advantageous to weightlifting performance and maximal force production. As such, the isometric peak force and contractile rate of force development of weightlifters is ~15-20% and ~13-16% greater, respectively, than in other strength and power athletes. In addition, weightlifting training has been shown to reduce the typical sex-related difference in the expression of neuromuscular strength and power. However, this apparent sex-related difference appears to be augmented with increasing adult age demonstrating that women undergo a greater age-related decline in muscle shortening velocity and peak power when compared with men. Weightlifting training and competition has been shown to induce significant structural and functional adaptations of the cardiovascular system. The collective evidence shows that these adaptations are physiological as opposed to pathological. Finally, the acute exercise-induced testosterone, cortisol and growth hormone responses of weightlifters have similarities to that of following conventional strength and hypertrophy protocols involving large muscle mass exercises. The routine assessment of the basal testosterone : cortisol ratio may be beneficial when attempting to quantify the adaptive responses to weightlifting training. As competitive weightlifting is becoming increasingly popular around the world, further research addressing the physiological responses and adaptations of female weightlifters and younger (i.e. ≤17 years of age) and older (i.e. ≥35 years of age) weightlifters of both sexes is required.

Maximal strength training and increased work efficiency: contribution from the trained muscle bed

Maximal strength training (MST) reduces pulmonary oxygen uptake (Vo(2)) at a given submaximal exercise work rate (i.e., efficiency). However, whether the increase in efficiency originates in the trained skeletal muscle, and therefore the impact of this adaptation on muscle blood flow and arterial-venous oxygen difference (a-vO(2diff)), is unknown. Thus five trained subjects partook in an 8-wk MST intervention consisting of half-squats with an emphasis on the rate of force development during the concentric phase of the movement. Pre- and posttraining measurements of pulmonary Vo(2) (indirect calorimetry), single-leg blood flow (thermodilution), and single-leg a-vO(2diff) (blood gases) were performed, to allow the assessment of skeletal muscle Vo(2) during submaximal cycling [237 ± 23 W; ∼60% of their peak pulmonary Vo(2) (Vo(2peak))]. Pulmonary Vo(2peak) (∼4.05 l/min) and peak work rate (∼355 W), assessed during a graded exercise test, were unaffected by MST. As expected, following MST there was a significant reduction in pulmonary Vo(2) during steady-state submaximal cycling (∼237 W: 3.2 ± 0.1 to 2.9 ± 0.1 l/min). This was accompanied by a significant reduction in single-leg Vo(2) (1,101 ± 105 to 935 ± 93 ml/min) and single-leg blood flow (6,670 ± 700 to 5,649 ± 641 ml/min), but no change in single-leg a-vO(2diff) (16.7 ± 0.8 to 16.8 ±0.4 ml/dl). These data confirm an MST-induced reduction in pulmonary Vo(2) during submaximal exercise and identify that this change in efficiency originates solely in skeletal muscle, reducing muscle blood flow, but not altering muscle a-vO(2diff).

Unique aspects of competitive weightlifting: performance, training and physiology

Weightlifting is a dynamic strength and power sport in which two, multijoint, whole-body lifts are performed in competition; the snatch and clean and jerk. During the performance of these lifts, weightlifters have achieved some of the highest absolute and relative peak power outputs reported in the literature. The training structure of competitive weightlifters is characterized by the frequent use of high-intensity resistance exercise movements. Varied coaching and training philosophies currently exist around the world and further research is required to substantiate the best type of training programme for male and female weightlifters of various age groups. As competitive weightlifting is contested over eight male and seven female body weight categories, the anthropometric characteristics of the athletes widely ranges. The body compositions of weightlifters are similar to that of athletes of comparable body mass in other strength and power sports. However, the shorter height and limb lengths of weightlifters provide mechanical advantages when lifting heavy loads by reducing the mechanical torque and the vertical distance that the barbell must be displaced. Furthermore, the shorter body dimensions coincide with a greater mean skeletal muscle cross-sectional area that is advantageous to weightlifting performance. Weightlifting training induces a high metabolic cost. Although dietary records demonstrate that weightlifters typically meet their required daily energy intake, weightlifters have been shown to over consume protein and fat at the expense of adequate carbohydrate. The resulting macronutrient imbalance may not yield optimal performance gains. Cross-sectional data suggest that weightlifting training induces type IIX to IIA fibre-type transformation. Furthermore, weightlifters exhibit hypertrophy of type II fibres that is advantageous to weightlifting performance and maximal force production. As such, the isometric peak force and contractile rate of force development of weightlifters is ~15-20% and ~13-16% greater, respectively, than in other strength and power athletes. In addition, weightlifting training has been shown to reduce the typical sex-related difference in the expression of neuromuscular strength and power. However, this apparent sex-related difference appears to be augmented with increasing adult age demonstrating that women undergo a greater age-related decline in muscle shortening velocity and peak power when compared with men. Weightlifting training and competition has been shown to induce significant structural and functional adaptations of the cardiovascular system. The collective evidence shows that these adaptations are physiological as opposed to pathological. Finally, the acute exercise-induced testosterone, cortisol and growth hormone responses of weightlifters have similarities to that of following conventional strength and hypertrophy protocols involving large muscle mass exercises. The routine assessment of the basal testosterone : cortisol ratio may be beneficial when attempting to quantify the adaptive responses to weightlifting training. As competitive weightlifting is becoming increasingly popular around the world, further research addressing the physiological responses and adaptations of female weightlifters and younger (i.e. ≤17 years of age) and older (i.e. ≥35 years of age) weightlifters of both sexes is required.

Anabolic steroid associated to physical training induces deleterious cardiac effects

PURPOSE

Cardiac aldosterone might be involved in the deleterious effects of nandrolone decanoate (ND) on the heart. Therefore, we investigated the involvement of cardiac aldosterone, by the pharmacological block of AT1 or mineralocorticoid receptors, on cardiac hypertrophy and fibrosis.

METHODS

Male Wistar rats were randomized into eight groups (n = 14 per group): Control (C), nandrolone decanoate (ND), trained (T), trained ND (TND), ND + losartan (ND + L), trained ND + losartan (TND + L), ND + spironolactone (ND + S), and trained ND + spironolactone (TND + S). ND (10 mg·kg(-1)·wk(-1)) was administered during 10 wk of swimming training (five times per week). Losartan (20 mg·kg(-1)·d(-1)) and spironolactone (10 mg·kg(-1)·d(-1)) were administered in drinking water.

RESULTS

Cardiac hypertrophy was increased 10% by using ND and 17% by ND plus training (P < 0.05). In both groups, there was an increase in the collagen volumetric fraction (CVF) and cardiac collagen type III expression (P < 0.05). The ND treatment increased left ventricle-angiotensin-converting enzyme I activity, AT1 receptor expression, aldosterone synthase (CYP11B2), and 11-β hydroxysteroid dehydrogenase 2 (11β-HSD2) gene expression and inflammatory markers, TGFβ and osteopontin. Both losartan and spironolactone inhibited the increase of CVF and collagen type III. In addition, both treatments inhibited the increase in left ventricle-angiotensin-converting enzyme I activity, CYP11B2, 11β-HSD2, TGFβ, and osteopontin induced by the ND treatment.

CONCLUSIONS

We believe this is the first study to show the effects of ND on cardiac aldosterone. Our results suggest that these effects may be associated to TGFβ and osteopontin. Thus, we conclude that the cardiac aldosterone has an important role on the deleterious effects on the heart induced by ND.

A systematic review of resting left ventricular systolic and diastolic function and adaptation in elite weightlifters

BACKGROUND

This review aims to establish what effect weightlifting has on the systolic and diastolic function of the left ventricular (LV).

SOURCES OF DATA

PubMed; ISI Web of Knowledge; Cochrane Library and Ovid Medline were searched in February 2012 to find literature on the effect of weightlifting on the LV cardiac function.

AREAS OF AGREEMENT

Stroke volume, posterior wall thickness and ventricular filling time and rate were seen to increase. A decrease in the resting heart rate was seen.

AREAS OF CONTROVERSY

Blood pressure and LV morphological changes were equivocal.

GROWING POINTS

Weightlifting causes recognizable functional change to the LV, some of these changes may confer benefits such as improvements in the systolic function.

AREAS TIMELY FOR DEVELOPING RESEARCH

Discrepancies exist with regard to regional LV morphological change, as the evidence suggests the LV does not adapt in a homogenous manner. Attempts should be made to separate performance-enhancing drug users from those who compete drug free.

Chemical cardiomyopathies: the negative effects of medications and nonprescribed drugs on the heart

The heart is a target of injury for many chemical compounds, both medically prescribed and not medically prescribed. Pathophysiologic mechanisms underlying the development of chemical-induced cardiomyopathies vary depending on the inciting agent, including direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. Numerous chemicals and drugs are implicated in cardiomyopathy. This article discusses examples of medication and nonprescribed drug-induced cardiomyopathies and reviews their pathophysiologic mechanisms.

A associação de esteroide anabolizante ao treinamento físico aeróbio leva a alterações morfológicas cardíacas e perda de função ventricular em ratos

INTRODUÇÃO: O esteroide anabolizante (EA) associado ao treinamento físico induz mudança da hipertrofia cardíaca (HC) fisiológica para patológica. Entretanto, esses trabalhos foram realizados com atletas de força, sendo os efeitos do EA associados ao treinamento aeróbio poucos conhecidos. Com isso, o objetivo do estudo foi avaliar os efeitos do treinamento aeróbio e dos EA sobre a estrutura e função cardíaca. MÉTODOS: Foram utilizados 28 ratos Wistar divididos em quatro grupos: sedentários controle (SC), sedentários anabolizante (SA), treinados controle (TC) e treinado anabolizante (TA). O EA foi administrado duas vezes por semana (10mg/kg/ semana). O treinamento físico de natação foi realizado durante 10 semanas, cinco sessões semanais. Foram avaliadas a pressão arterial e frequência cardíaca por pletismografia de cauda, função ventricular por ecocardiografia, diâmetro dos cardiomiócitos e fração volume de colágeno por métodos histológicos. RESULTADOS: Não foram observadas diferenças na PA. O grupo TC apresentou redução da frequência cardíaca de repouso após o período experimental, o que não ocorreu no grupo TA. Foram observadas HC de 38% no grupo SA, 52% no grupo TC e de 64% no grupo TA em relação ao grupo SC. O grupo TA apresentou diminuição da função diastólica em relação aos outros grupos. Os grupos treinados apresentaram aumentos significantes no diâmetro dos cardiomiócitos. Os grupos SA e TA apresentaram aumento na fração volume de colágeno em relação aos grupos SC e TC. CONCLUSÃO: Os resultados apresentados mostram que o treinamento físico de natação induz a HC, principalmente pelo aumento do colágeno intersticial, o que pode levar a prejuízos da função diastólica.

Androgenic anabolic steroid abuse and the cardiovascular system

Abuse of anabolic androgenic steroids (AAS) has been linked to a variety of different cardiovascular side effects. In case reports, acute myocardial infarction is the most common event presented, but other adverse cardiovascular effects such as left ventricular hypertrophy, reduced left ventricular function, arterial thrombosis, pulmonary embolism and several cases of sudden cardiac death have also been reported. However, to date there are no prospective, randomized, interventional studies on the long-term cardiovascular effects of abuse of AAS. In this review we have studied the relevant literature regarding several risk factors for cardiovascular disease where the effects of AAS have been scrutinized:(1) Echocardiographic studies show that supraphysiologic doses of AAS lead to both morphologic and functional changes of the heart. These include a tendency to produce myocardial hypertrophy (Fig. 3), a possible increase of heart chamber diameters, unequivocal alterations of diastolic function and ventricular relaxation, and most likely a subclinically compromised left ventricular contractile function. (2) AAS induce a mild, but transient increase of blood pressure. However, the clinical significance of this effect remains modest. (3) Furthermore, AAS confer an enhanced pro-thrombotic state, most prominently through an activation of platelet aggregability. The concomitant effects on the humoral coagulation cascade are more complex and include activation of both pro-coagulatory and fibrinolytic pathways. (4) Users of AAS often demonstrate unfavorable measurements of vascular reactivity involving endothelial-dependent or endothelial-independent vasodilatation. A degree of reversibility seems to be consistent, though. (5) There is a comprehensive body of evidence documenting that AAS induce various alterations of lipid metabolism. The most prominent changes are concomitant elevations of LDL and decreases of HDL, effects that increase the risk of coronary artery disease. And finally, (6) the use of AAS appears to confer an increased risk of life-threatening arrhythmia leading to sudden death, although the underlying mechanisms are still far from being elucidated. Taken together, various lines of evidence involving a variety of pathophysiologic mechanisms suggest an increased risk for cardiovascular disease in users of anabolic androgenic steroids.

Anabolics and cardiomyopathy in a bodybuilder: case report and literature review

BACKGROUND

Athletes use androgenic-anabolic steroids to increase strength and muscle mass. Several case reports suggest that it may lead to dilated cardiomyopathy.

METHODS AND RESULTS

We report a case of a 41-year-old bodybuilder with severe systolic dysfunction and Class IV heart failure despite maximal medical therapy. He used anabolic steroids and insulin growth factor, and did not have any other risk factors for cardiomyopathy. We briefly review the literature and summarize other reported cases with similar scenarios. In most of them cardiomyopathy was at least partially reversible after discontinuation of anabolics.

CONCLUSIONS

Abuse of anabolic steroids may be an uncommon cause of cardiomyopathy in young and otherwise healthy individuals.

Cardiovascular adaptive responses in rats submitted to moderate resistance training

The present study investigated the effects of 8 week of resistance training (RT) on hemodynamic and ventricular function on cardiac myosin ATPase activity, and on contractility of papillary muscles of rats. Groups: control (CO), electrically stimulated (ES), trained at 60% (TR 60%) and 75% of one repetition maximum (1RM) (TR 75%). Exercise protocol: 5 sets of 12 repetitions at 60 and 75% of 1RM, 5 times per week. The CO and ES groups had similar values for parameters analyzed (P > 0.05). Blood pressure (BP), heart rate (13%), left ventricle systolic pressure (LVSP 13%) decreased and cardiac myosin ATPase activity increased in the TR 75% group (90%, P < 0.05). The contractile performance of papillary muscles increased in trained rats (P < 0.05). Eight weeks of RT was associated with lowering of resting BP, heart rate and LVSP, improvements in contractility of the papillary muscle and an increase of cardiac myosin ATPase activity in rats.

Left ventricular mass in elite olympic weight lifters

The existence of resistance training-induced left ventricular (LV) concentric hypertrophy is equivocal. Although some have described significant LV hypertrophy, others have suggested that training-induced LV hypertrophy is proportional to increased fat free mass (FFM) and thus a normal physiologic response to training. Method limitations, steroid use, and type of training may contribute to discrepant findings. Thus, LV structure and volumes are determined using magnetic resonance imaging. Body composition was determined using dual-energy x-ray absorptiometry in 9 elite Olympic weight lifters and 10 age- and weight-matched recreationally active controls. LV structure and volumes were determined by acquiring 6 short- and 3 long-axis magnetic resonance imaging scans of the left ventricle, whereas LV wall thickness was defined as the average of 6 midventricular segment thickness measurements. Weight lifters had the same age, weight, and FFM, but were shorter and had a greater body mass index than controls. LV mass was not different in weight lifters and controls, but was lower in weight lifters when indexed to FFM (2.56 +/- 0.07 vs 2.30 +/- 0.05, p = 0.01). LV mass correlated with FFM (r = 0.49, p = 0.04). However, LV mass was lower in weight lifters for a given FFM. LV wall thickness, as well as end-diastolic, end-systolic, and stroke volumes, were not different between groups. In conclusion, these results refute the hypothesis that resistance training induces LV concentric hypertrophy and suggest that Olympic weight lifting is associated with increases in FFM without a concomitant increase in LV mass.

Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism

Prescribed and supervised resistance training (RT) enhances muscular strength and endurance, functional capacity and independence, and quality of life while reducing disability in persons with and without cardiovascular disease. These benefits have made RT an accepted component of programs for health and fitness. The American Heart Association recommendations describing the rationale for participation in and considerations for prescribing RT were published in 2000. This update provides current information regarding the (1) health benefits of RT, (2) impact of RT on the cardiovascular system structure and function, (3) role of RT in modifying cardiovascular disease risk factors, (4) benefits in selected populations, (5) process of medical evaluation for participation in RT, and (6) prescriptive methods. The purpose of this update is to provide clinicians with recommendations to facilitate the use of this valuable modality.

Cardiac tissue Doppler imaging in sports medicine

The differentiation of training-induced cardiac adaptations from pathological conditions is a key issue in sports cardiology. As morphological features do not allow for a clear delineation of early stages of relevant pathologies, the echocardiographic evaluation of left ventricular function is the technique of first choice in this regard. Tissue Doppler imaging (TDI) is a relatively recent method for the assessment of cardiac function that provides direct, local measurements of myocardial velocities throughout the cardiac cycle. Although it has shown a superior sensitivity in the detection of ventricular dysfunction in clinical and experimental studies, its application in sports medicine is still rare. Besides technical factors, this may be due to a lack in consensus on the characteristics of ventricular function in relevant conditions. For more than two decades there has been an ongoing debate on the existence of a supernormal left ventricular function in athlete's heart. While results from traditional echocardiography are conflicting, TDI studies established an improved diastolic function in endurance-trained athletes with athlete's heart compared with controls.The influence of anabolic steroids on cardiac function also has been investigated by standard echocardiographic techniques with inconsistent results. The only TDI study dealing with this topic demonstrated a significantly impaired diastolic function in bodybuilders with long-term abuse of anabolic steroids compared with strength-trained athletes without abuse of anabolic steroids and controls, respectively.Hypertrophic cardiomyopathy is the most frequent cause of sudden death in young athletes. However, in its early stages, it is difficult to distinguish from athlete's heart. By means of TDI, ventricular dysfunction in hypertrophic cardiomyopathy can be disclosed even before the development of left ventricular hypertrophy. Also, a differentiation of left ventricular hypertrophy due to hypertrophic cardiomyopathy or systemic hypertension is possible by TDI. Besides the evaluation of different forms of left ventricular hypertrophy, the diagnosis of myocarditis is also of particular importance in athletes. Today, it still requires myocardial biopsy. The analysis of focal disturbances in myocardial velocities might be a promising non-invasive method; however, systematic validation studies are lacking. An important future issue for the implementation of TDI into routine examination will be the standardisation of procedures and the establishment of significant reference values for the above-mentioned conditions. Innovative TDI parameters also merit further investigation.

Cardiovascular effects of androgenic anabolic steroids in male bodybuilders determined by tissue Doppler imaging

The effects of anabolic androgenic steroids (AASs) on left ventricular (LV) diastolic function in strength-trained athletes are controversial. The main objective of this study was to evaluate the effects of regular AAS administration in bodybuilders using pulsed tissue Doppler imaging (TDI) to evaluate LV relaxation properties. Fifteen male bodybuilders with a history of intensive, long-term strength training and 16 age-matched sedentary controls were recruited. Six of the bodybuilders reported regular use of AASs, and 9 were drug free. To assess LV diastolic function, each subject underwent standard Doppler echocardiography and pulsed TDI. Drug-using bodybuilders exhibited altered LV diastolic filling characterized by a smaller contribution of passive filling to LV filling compared with their drug-free counterparts. TDI measurements indicated that drug-using bodybuilders had smaller peak E(m) than drug-free bodybuilders and sedentary controls, except at the level of the anterior wall, at which peak E(m) was significantly smaller than in drug-free bodybuilders only. The E/E(m) ratio, an index of LV filling pressures, was not affected by strength training or by AAS use. Drug-using bodybuilders exhibited larger LV end-diastolic diameters, volumes, and masses than their drug-free counterparts. However, no difference was found in LV wall thickness between the groups. In conclusion, drug-using bodybuilders showed a decrease in the contribution in LV passive filling to LV filling associated with a decrease in LV relaxation properties. Because no wall thickening was obtained in drug-using bodybuilders, the decrease in LV relaxation properties might have been be due to an alteration in the active properties of the myocardium, but that has yet to be confirmed.

Cardiac autonomic dysfunction in rats chronically treated with anabolic steroid

To date no published data exist regarding the effects of chronic high-dose anabolic-androgenic steroid administration on tonic cardiac autonomic control. The aim of this study was to evaluate, by power spectral analysis of heart rate variability (HRV), the effects of chronic treatment with supraphysiological doses of nandrolone decanoate (DECA) on tonic cardiac autonomic regulation in sedentary rats. Male Wistar rats were treated weekly with 10 mg kg(-1) of DECA (n=7) or vehicle (CONTROL, n=7) for 10 weeks. At the 8th week of treatment, electrocardiogram was recorded in the conscious state, for time- and frequency-domain HRV analysis. Parasympathetic indexes were reduced in DECA group: high-frequency power (CONTROL=11.1+/-3.0 ms2 vs. DECA=3.8+/-0.6 ms2, P<0.05), RMSSD (CONTROL=5.9+/-0.9 ms vs. DECA 3.5+/-0.3 ms; P<0.05) and pNN5 (CONTROL=31.5+/-7.5 ms vs. DECA=13.2+/-2.6 ms; P<0.05). The sympathetic index LF/HF tended to be higher in DECA group (CONTROL=0.65+/-0.15 vs. DECA=1.17+/-0.26, P=0.0546). In conclusion, chronic treatment with DECA, in rats, impairs tonic cardiac autonomic regulation, which may provide a key mechanism for anabolic steroid-induced arrhythmia and sudden cardiac death.

Testosterone induces an intracellular calcium increase by a nongenomic mechanism in cultured rat cardiac myocytes

Androgens are associated with important effects on the heart, such as hypertrophy or apoptosis. These responses involve the intracellular androgen receptor. However, the mechanisms of how androgens activate several membrane signaling pathways are not fully elucidated. We have investigated the effect of testosterone on intracellular calcium in cultured rat cardiac myocytes. Using fluo3-AM and epifluorescence microscopy, we found that exposure to testosterone rapidly (1-7 min) led to an increase of intracellular Ca2+, an effect that persisted in the absence of external Ca2+. Immunocytochemical analysis showed that these effects occurred before translocation of the intracellular androgen receptor to the perinuclear zone. Pretreatment of the cells with 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid-acetoxymethylester and thapsigargin blocked this response, suggesting the involvement of internal Ca2+ stores. U-73122, an inhibitor of phospholipase C, and xestospongin C, an inhibitor of inositol 1,4,5-trisphosphate receptor, abolished the Ca2+ signal. The rise in intracellular Ca2+ was not inhibited by cyproterone, an antagonist of intracellular androgen receptor. Moreover, the cell impermeant testosterone-BSA complex also produced the Ca2+ signal, indicating its origin in the plasma membrane. This effect was observed in cultured neonatal and adult rat cardiac myocytes. Pertussis toxin and the adenoviral transduction of beta- adrenergic receptor kinase carboxy terminal peptide, a peptide inhibitor of betagamma-subunits of G protein, abolished the testosterone-induced Ca2+ release. In summary, this is the first study of rapid, nongenomic intracellular Ca2+ signaling of testosterone in cardiac myocytes. Using various inhibitors and testosterone-BSA complex, the mechanism for the rapid, testosterone-induced increase in intracellular Ca2+ is through activation of a plasma membrane receptor associated with a Pertussis toxin-sensitive G protein-phospholipase C/inositol 1,4,5-trisphosphate signaling pathway.

Preservation of Ventricular Function in Amateur Athletes After Completion of a Marathon

BACKGROUND

Previous studies have demonstrated the development of impaired systolic function and new segmental wall motion abnormalities following completion of ultraendurance events. Limited information is available on the effect of an endurance event such as a marathon on the left ventricular indices and hemodynamics.

METHODS

We examined 45 patients (26 men, 19 women with the average age of 35+/- 8 years) who successfully trained and completed the 2001 Chicago Marathon (26.2 miles). Transthoracic 2-dimensional and Doppler echocardiography (TTE) was preformed prior to the marathon (17+/-10.7 days), immediately following the marathon (71+/-42 minutes), and at follow-up (29+/-12.9 days).

RESULTS

Left ventricular end diastolic volumes declined immediately post marathon and returned to baseline at the one-month follow-up. Ejection fraction was maintained and no regional wall motion abnormalities were identified at any time point. Diastolic parameters decreased immediately post marathon but returned to baseline during follow-up principally reflecting a change in volume status.

CONCLUSION

Marathon running by a group of well-trained recreational athletes does not result in impairment of left ventricular systolic or diastolic function.

Effects of chronic anabolic steroid treatment on tonic and reflex cardiovascular control in male rats

The aim of this study was to analyze the cardiovascular effects of chronic stanozolol administration in male rats. The rats were randomly assigned to one of three groups: (1) control (n=12), (2) chronic treatment with low dose of stanozolol (LD, n=18, 5 mg/kgweek) and; (3) treatment with high dose of stanozolol (HD, n=28, 20 mg/kgweek). Mean arterial pressure (MAP) was higher in both HD (128+/-2.2 mmHg) and LD (126+/-2.5 mmHg) than control (116+/-2 mmHg). The LD group showed an increase in cardiac output (control 121+/-2.5, LD 154+/-5.9 ml/min), whereas in the HD group total peripheral resistance increased (control 1.03+/-0.07, HD 1.26+/-0.07 mmHg/ml/min). Acute sympathetic blockade caused a similar decrease in MAP in all groups. In conscious rats, the baroreflex index for bradycardia (control -3.7+/-0.4, LD -2.0+/-0.1 beat/mmHg) and tachycardia (control -3.6+/-0.3, LD -4.7+/-0.2 beat/mmHg) responses changed only in the LD group. Cardiac hypertrophy was observed in both treated groups (P<0.05). In conclusion, hypertension with differential hemodynamic changes and alterations in the reflex control in heart rate is seen at different stanozolol doses, which may be important variables in the cardiovascular effects of anabolic steroids.

Are the cardiac effects of anabolic steroid abuse in strength athletes reversible?

OBJECTIVE

To investigate the reversibility of adverse cardiovascular effects after chronic abuse of anabolic androgenic steroids (AAS) in athletes.

METHODS

Doppler echocardiography and cycle ergometry including measurements of blood pressure at rest and during exercise were undertaken in 32 bodybuilders or powerlifters, including 15 athletes who had not been taking AAS for at least 12 months (ex-users) and 17 currently abusing AAS (users), as well as in 15 anabolic-free weightlifters.

RESULTS

Systolic blood pressure was higher in users (mean (SD) 140 (10) mm Hg) than in ex-users (130 (5) mm Hg) (p < 0.05) or weightlifters (125 (10) mm Hg; p < 0.001). Left ventricular muscle mass related to fat-free body mass and the ratio of mean left ventricular wall thickness to internal diameter were not significantly higher in users (3.32 (0.48) g/kg and 42.1 (4.4)%) than in ex-users (3.16 (0.53) g/kg and 40.3 (3.8)%), but were lower in weightlifters (2.43 (0.26) g/kg and 36.5 (4.0)%; p < 0.001). Left ventricular wall thickness related to fat-free body mass was also lower in weightlifters, but did not differ between users and ex-users. Left ventricular wall thickness was correlated with a point score estimating AAS abuse in users (r = 0.49, p < 0.05). In all groups, systolic left ventricular function was within the normal range. The maximum late transmitral Doppler flow velocity (Amax) was higher in users (61 (12) cm/s) and ex-users (60 (12) cm/s) than in weightlifters (50 (9) cm/s; p < 0.05 and p = 0.054).

CONCLUSIONS

Several years after discontinuation of anabolic steroid abuse, strength athletes still show a slight concentric left ventricular hypertrophy in comparison with AAS-free strength athletes.

The effects of anabolic-androgenic steroids upon resting and peak exercise left ventricular heart wall motion kinetics in male strength and power athletes

Previous investigations reported alterations in myocardial fibres and systolic function associated with anabolic-androgenic steroid consumption by athletes. Advances in bio-medical technology have allowed further investigation in assessing the possible effects of anabolic-androgenic steroids on gross left ventricular kinetics. Twenty-three male strength and power athletes with a past and current history of anabolic-androgenic steroid consumption (x 46 days, range 28 days to 70 days), were compared to 23 controls. Testing consisted of resting and immediate post-exercise transthoracic left ventricular wall cardiokymograms. Statistical results identified no difference over time between groups or condition. Cardiokymographic waveform analysis found 32.61% of all (n =184) waveforms to be abnormal (Type II, n = 56 or Type III, n = 4). There were 14 treatment subjects (60.87%) who demonstrated an abnormal waveform as compared to 9 controls (39.13%). A significant difference (p < or = 0.01) in the overall proportions of waveform types was identified where the treatment group exhibited 41.30% abnormal waveforms, compared to 23.91% by controls. Additionally, two athletes (1 treatment, 1 control) demonstrated abnormal left ventricular wall motions (Type III) analogous to impaired left ventricular performance. The results indicated: (a) highly strength trained athletes with no history of anabolic-androgenic steroid usage exhibited an unexpected high incidence of Type II waveforms (28.26% pre/23.91% post); (b) a comparable group of strength trained athletes using anabolic-androgenic steroids exhibited a significantly higher percentage of abnormal waveforms as compared to controls (34.78% pre/37.21% post). Based on these results, high intensity strength training with and without anabolic-androgenic steroid supplementation induced alterations in the left ventricular wall motion.

Echocardiographic parameters in adolescents with sleep-related breathing disorders

Few data are known about the effects of sleep-related breathing disorders (SRBD) on the cardiovascular system in adolescents. Forty healthy adolescents (mean age, 13.7 +/- 1.6 years) answered a questionnaire regarding symptoms of sleep-related breathing disorders (SRBD) and underwent a cardiorespiratory polygraphy and echocardiography. Echocardiographic data in snorers with polygraphic abnormalities suggestive of SRBD (positive group, n = 29) were compared with the results in nonsnorers without polygraphic abnormalities (n = 11) who were included in the control group. Ventricular dimensions and indices of left ventricular systolic function were within normal limits and were not significantly different between the two groups. Indices of left ventricular diastolic function were also within normal limits, but isovolumetric relaxation time (IVRT) was significantly longer among the positive group (72.5 +/- 8.4 msec) than among the controls (65.1 +/- 7.9 msec) (P = 0.018). Multiple regression analysis showed that posterior wall thickness was predicted by a model that included cardiac events related with respiratory events and/or desaturations, and respiratory disturbance index (RDI) in supine position. Deceleration of early diastolic flow was predicted by RDI, percentage of total recording time with SaO(2) < 90% (CT(90)), and age; the variability of isovolumetric relaxation time was predicted by a model that included RDI in supine position. We found a significant relationship between polygraphic parameters suggestive of SRBD and echocardiographic measurements of ventricular dimensions and diastolic function. Also, echocardiographic parameters suggestive of some degree of left ventricular diastolic dysfunction were found in snoring adolescents with polygraphic abnormalities.

Resistance training and cardiac hypertrophy: unravelling the training effect

Resistance training (RT) is a popular method of conditioning to enhance sport performance as well as an effective form of exercise to attenuate the age-mediated decline in muscle strength and mass. Although the benefits of RT on skeletal muscle morphology and function are well established, its effect on left ventricular (LV) morphology remains equivocal. Some investigations have found that RT is associated with an obligatory increase in LV wall thickness and mass with minimal alteration in LV internal cavity dimension, an effect called concentric hypertrophy. However, others report that short- (<5 years) to long-term (>18 years) RT does not alter LV morphology, arguing that concentric hypertrophy is not an obligatory adaptation secondary to this form of exertion. This disparity between studies on whether RT consistently results in cardiac hypertrophy could be caused by: (i) acute cardiopulmonary mechanisms that minimise the increase in transmural pressure (i.e. ventricular pressure minus intrathoracic pressure) and LV wall stress during exercise; (ii) the underlying use of anabolic steroids by the athletes; or (iii) the specific type of RT performed. We propose that when LV geometry is altered after RT, the pattern is usually concentric hypertrophy in Olympic weightlifters. However, the pattern of eccentric hypertrophy (increased LV mass secondary to an increase in diastolic internal cavity dimension and wall thickness) is not uncommon in bodybuilders. Of particular interest, nearly 40% of all RT athletes have normal LV geometry, and these athletes are typically powerlifters. RT athletes who use anabolic steroids have been shown to have significantly higher LV mass compared with drug-free sport-matched athletes. This brief review will sort out some of the factors that may affect the acute and chronic outcome of RT on LV morphology. In addition, a conceptual framework is offered to help explain why cardiac hypertrophy is not always found in RT athletes.

Assessment of regional systolic and diastolic wall motion velocities in highly trained athletes by pulsed wave Doppler tissue imaging

We studied the relationship between left ventricular (LV) function and the increased LV mass in 18 highly trained rowing athletes (14 men, 4 women; mean age 20.7 +/- 4.5 years) using pulsed wave Doppler tissue imaging (PWDTI). Thirteen untrained volunteers, matched for age and body mass index, acted as control participants. Peak systolic, early diastolic (Ev), and late diastolic (Av) myocardial velocities (cm/s); Ev/Av ratio; and isovolumic relaxation time (ms) were measured at the level of basal lateral wall and basal posterior interventricular septum (bas-IVS) segments. In comparison with control participants, athletes showed a greater LV cavity size (P <.05), wall thickness (IVS, P <.001; posterior wall, P <.01), and mass index (P <.001). In athletes, systolic velocity of bas-IVS had increased (P <.001) and was positively correlated with IVS thickness (r = 0.66, P <.005) and LV mass index (r = 0.71, P <.001). Of the PWDTI-measured diastolic indexes, Ev/Av ratio significantly increased in athletes in comparison with control participants in both the examined segments (bas-IVS, P <.05; basal lateral wall, P <.05). When Ev and Av were separately considered, a different behavior was found in the 2 segments: Ev significantly increased in the basal lateral wall (P <.005); Av significantly decreased in the bas-IVS. The increase in the systolic velocity of bas-IVS suggests that septum greatly contributes to the longitudinal LV systolic shortening and increase of stroke volume in athletes compared with untrained participants. Moreover, the behavior of PWDTI diastolic velocities suggests a more effective relaxation activity in the longitudinal axis at the level of lateral wall. This study suggests therefore the usefulness of PWDTI in the assessment of functional properties of "athlete's heart" and differentiation from pathologic cardiac conditions.

Echocardiographic changes in the development of the athlete' s heart in 9 to 20-year-old male subjects

The purpose of this cross-sectional investigation was to estimate the age at which specific traits of the "athlete's heart" first appear and how they evolve from the beginning of regular physical training until young adulthood in healthy active males. Male athletes (n=389) and non-athletes (n=55) aged between 9 and 20 years were examined by two-dimensionally guided M-mode and Doppler echocardiography. Intragroup differences were examined by t-tests for independent samples between age groups of two years each. Morphologic variables were related to body size by using ratio indices in which the power terms of numerator and denominator were matched. Relative left ventricular muscle mass (LVMM) was significantly larger in the athletic males at age of 11-12, and this significant difference was maintained with advancing age. Most of this increase of LVMM could be attributed to the increase in wall thickness that became significantly manifest first in the 13- to 14-year-old athletic subjects but was demonstrable in all the other groups. A significantly larger left ventricular internal diameter was only found in the age-group of 15-16. Fractional shortening percentage (FS%) did not show any change, while resting heart rate was decreased in our athletic groups.

Echocardiographic characteristics of male athletes of different age

Two dimensionally guided M mode and Doppler echocardiographic data for 578 male subjects (106 non-athletic and 472 athletes) were analysed from two aspects: (a) in the young adult category (19--30 years of age), competitors in different groups of sports were studied; (b) in the different age groups (children, 10--14 years; adolescent juniors, 15--18 years; young adults, 19--30 years; adults, 31--44 years; older adults 45--60 years), data for athletes and non-athletes were compared. Morphological variables were related to body size by indices in which the exponents of the numerator and denominator were matched. Morphological signs of athletic heart were most consistently evident in the left ventricular muscle mass: in the young adult group, the highest values were seen in the endurance athletes, followed by the ball game players, sprinters/jumpers, and power athletes. A thicker muscular wall was the main reason for this hypertrophy. Internal diameter was only increased in the endurance athletes, and this increase was more evident in the younger groups. The E/A quotient (ratio of peak velocity during early and late diastole) indicated more effective diastolic function in the endurance athletes. The values for E/A quotient also suggested that regular physical activity at an older age may protect against age dependent impairment of diastolic function.

The effects of 17 alpha-methyltestosterone on myocardial function in vitro

Testosterone analogs have been used as performance enhancers by athletes for more than 40 yr. We asked whether the anabolic steroid 17 alpha-methyl-4-androstene-17-ol-3-one (17 alpha-MT) would affect intrinsic contractile function of the heart. Male Sprague-Dawley rats, 125-150 g, were treated with 17 alpha-MT either parenterally or orally for up to 8 wk. Intrinsic contractile function of the hearts was assessed utilizing both the isolated working heart and isovolumic perfused heart preparations. Isolated working hearts from 17 alpha-MT-treated rats had a 45% decrease in heart work attributable largely to a similarly decreased stroke volume. Isovolumic perfused hearts from treated animals had elevated left ventricular systolic and diastolic pressures at similar interventricular volumes compared to controls. Rates of ventricular pressure development (+dP/dT) or relaxation (-dP/dT) were unchanged as a result of the treatment. However, static elastance was reduced in potassium-arrested hearts from the 17 alpha-MT treatment (63% increase in interventricular pressure), consistent with a limitation being imposed on stroke volume by a decreased myocardial compliance. Hydroxyproline content of the hearts was not altered by 17 alpha-MT treatment suggesting that increased stiffness was not a consequence of collagen proliferation. Treatment of the steroid rats with beta-aminopropionitrile, a compound that inhibits lysyl oxidase, restored the left ventricular volume-pressure relationship (elastance curve) to that of control hearts. Thus, chronic treatment with anabolic steroids appears to reduce left ventricular compliance, possibly related to an enhanced activity of lysyl oxidase, and results in increased crosslink formation between collagen strands in the extracellular matrix.

Effects of an androgenic steroid on exercise-induced cardiac remodeling in rats

Habitual exercise results in a rightward shift in left ventricular end diastolic (LVED) pressure-volume or internal dimension (P-D) relationships [left ventricular (LV) remodeling]. However, exercise-mediated LV hypertrophy (LVH) produces an increased LV relative wall thickness [ratio (h/r) of wall thickness (h) to internal radius (r)] and hence a decrement in diastolic wall stress despite LV remodeling. In this study, the effect of chronic administration of an androgenic steroid on exercise-induced LV remodeling and h/r was examined in rats. Habitual exercise on voluntary running wheels resulted in LVH and a rightward shift in the LVED P-D relationships. However, LVH was sufficient to increase LVED h/r. Androgenic steroid administration to exercised rats, without influencing the development of exercise-induced LVH, produced a further rightward shift in the LVED P-D relationship associated with an increased diameter intercept. As a consequence, LVED h/r was reduced to control values. The steroid-mediated effects were not associated with alterations in either the quantity or quality of LV collagen. In conclusion, high-dose androgenic steroid administration alters exercise-induced LV remodeling and subsequently reduces the beneficial effect of physiological LVH on LV h/r.

The athlete's heart. A meta-analysis of cardiac structure and function

BACKGROUND

It has been postulated that depending on the type of exercise performed, 2 different morphological forms of athlete's heart may be distinguished: a strength-trained heart and an endurance-trained heart. Individual studies have not tested this hypothesis satisfactorily.

METHODS AND RESULTS

The hypothesis of divergent cardiac adaptations in endurance-trained and strength-trained athletes was tested by applying meta-analytical techniques with the assumption of a random study effects model incorporating all published echocardiographic data on structure and function of male athletes engaged in purely dynamic (running) or static (weight lifting, power lifting, bodybuilding, throwing, wrestling) sports and combined dynamic and static sports (cycling and rowing). The analysis encompassed 59 studies and 1451 athletes. The overall mean relative left ventricular wall thickness of control subjects (0.36 mm) was significantly smaller than that of endurance-trained athletes (0.39 mm, P=0.001), combined endurance- and strength-trained athletes (0.40 mm, P=0.001), or strength-trained athletes (0.44 mm, P<0.001). There was a significant difference between the 3 groups of athletes and control subjects with respect to left ventricular internal diameter (P<0. 001), posterior wall thickness (P<0.001), and interventricular septum thickness (P<0.001). In addition, endurance-trained athletes and strength-trained athletes differed significantly with respect to mean relative wall thickness (0.39 versus 0.44, P=0.006) and interventricular septum thickness (10.5 versus 11.8 mm, P=0.005) and showed a trend toward a difference with respect to posterior wall thickness (10.3 versus 11.0 mm, P=0.078) and left ventricular internal diameter (53.7 versus 52.1 mm, P=0.055). With respect to cardiac function, there were no significant differences between athletes and control subjects in left ventricular ejection fraction, fractional shortening, and E/A ratio.

CONCLUSIONS

Results of this meta-analysis regarding athlete's heart confirm the hypothesis of divergent cardiac adaptations in dynamic and static sports. Overall, athlete's heart demonstrated normal systolic and diastolic cardiac functions.

Echocardiographic Doppler evaluation of left ventricular diastolic filling in older, highly trained male endurance athletes

Previously published data have suggested that endurance training does not retard the normative aging impairment of early left ventricular diastolic filling (LVDF). Those studies, suggesting no effect of exercise training, have not examined highly trained endurance athletes or their LVDF responses after exercise. We therefore compared LVDF characteristics in a group of older highly trained endurance athletes (n = 12, mean age 69 years, range 65-75) and a group of sedentary control subjects (n = 12, mean age 69 years, range 65-73) with no cardiovascular disease. For all subjects, M-mode and Doppler echocardiographic data were obtained at rest. After baseline studies, subjects underwent graded, maximal cardiopulmonary treadmill exercise testing using a modified Balke protocol. Breath-by-breath respiratory gas analysis and peak exercise oxygen consumption (VO(2)max) measurements were obtained. Immediately after exercise and at 3-6 minutes into recovery, repeat Doppler echocardiographic data were obtained for determination of LVDF parameters. VO(2)max (44 +/-6.3 vs 27+/-4.2 ml/kg/min, P<0.001), oxygen consumption at anaerobic threshold (35+/-5.4 vs 24+/-3.8 ml/kg/min, P<0.001), exercise duration (24+/-3 vs 12+/-6 minutes, P<0.001), and left ventricular mass index (61+/-13 vs 51+/-7.8 kg/m(2), P<0.05) were greater in endurance athletes than in sedentary control subjects, whereas body mass index was lower (22+/-1.7 vs 26+/-3.4 kg/m(2), P<0.001). No differences in any of the LVDF characteristics were observed between the groups with the exception of a trend toward a lower atrial filling fraction at rest in the endurance athlete group versus the control subjects (P = 0.07). High-intensity endurance exercise training promotes exceptional peak exercise oxygen consumption and cardiovascular stamina but does not appear to alter normative aging effects on left ventricular diastolic function.

Muscular strength training is associated with low arterial compliance and high pulse pressure

Aerobic exercise training increases arterial compliance and reduces systolic blood pressure, but the effects of muscular strength training on arterial mechanical properties are unknown. We compared blood pressure, whole body arterial compliance, aortic impedance, aortic stiffness (measured by beta-index and carotid pulse pressure divided by normalized systolic expansion [Ep]), pulse wave velocity, and left ventricular parameters in 19 muscular strength-trained athletes (mean+/-SD age, 26+/-4 years) and 19 sedentary controls (26+/-5 years). Subjects were healthy, non-steroid-using, nonsmoking males, and athletes had been engaged in a strength-training program with no aerobic component for a minimum of 12 months. There was no difference in maximum oxygen consumption between groups, but handgrip strength (mean+/-SEM, 44+/-2 versus 56+/-2 kg; P<0.01) and left ventricular mass (168+/-8 versus 190+/-8 g; P<0.05) were greater in athletes. Arterial stiffness was higher in athletes, as evidenced by lower whole body arterial compliance (0.40+/-0.04 versus 0.54+/-0.04 arbitrary compliance units; P=0.01), higher aortic characteristic impedance (1.55+/-0.13 versus 1.18+/-0.08 mm Hg. s. cm-1; P<0.05), beta-index (4.6+/-0.2 versus 3.8+/-0.4; P<0. 05), and ln Ep (10.86+/-0.06 versus 10.60+/-0.08; P<0.01). Femoral-dorsalis pedis pulse wave velocity was also higher in the athletes, but carotid-femoral pulse wave velocity was not different. Furthermore, both carotid (56+/-3 versus 44+/-2 mm Hg; P<0.001) and brachial (60+/-3 versus 50+/-2 mm Hg; P<0.01) pulse pressures were higher in the athletes, but mean arterial pressure and resting heart rate did not differ between groups. These data indicate that both the proximal aorta and the leg arteries are stiffer in strength-trained individuals and contribute to a higher cardiac afterload.

Effect of oxymetholone on left ventricular dimensions in heart failure secondary to idiopathic dilated cardiomyopathy or to mitral or aortic regurgitation

This study suggests that the short-term administration of a small dosage of anabolic steroids may have a beneficial effect on the deteriorated myocardium, although long-standing exposure to a larger dosage of anabolic steroids may induce myocardial and systemic complications.

Left ventricular filling profiles and angiotensin system activity in elite baseball players

Left ventricular (LV) filling profiles in elite baseball players has not been reported in the literature. Also, angiotensin system activity in athletes has never been reported. We used echocardiography to compare 20 male elite baseball players (aged 21.9+/-1.0 years) with those of age- and sex-matched healthy sedentary subjects. Compared with the normal group, the athlete group showed a significant increase in LV mass, LV diastolic and systolic dimension, and left atrial dimension (P<0.05, <0.001, <0.001, and <0.001, respectively). No differences in relative wall thickness or fractional shortening were found between these two groups. Diastolic filling profiles, including peak early diastolic filling velocity (E), peak late diastolic filling velocity (A), E:A ratio, early time-velocity integral (Ei), atrial time-velocity integral (Ai), Ei:Ai ratio, early filling time, deceleration time of early filling, and isovolumic relaxation time, were similar in both groups. Angiotensin system activity, including plasma renin activity, plasma aldosterone, and 24-h urinary aldosterone excretion, showed no difference between these two groups.

CONCLUSION

This study suggests that normal LV filling profile, which is mediated partly by normal angiotensin system activity, is not related to increase in LV dimension and mass in elite baseball players.