A New Frontier in Cardiovascular Prevention: Beyond Prohibition, Clinical Management of Anabolic Steroid Users

Subclinical Diagnosis: The Role of Advanced Echocardiography

Conventional cardiac assessment often fails to detect early damage, as Left Ventricular Ejection Fraction (LVEF) may remain within normal limits despite established myocardial injury. The literature highlights that AAS users exhibit alterations in cardiac geometry and function, including pathological hypertrophy, diastolic dysfunction, and biventricular impairment.^,

In this setting, echocardiography incorporating advanced measurements such as myocardial strain has emerged as an essential diagnostic tool. Although LVEF may remain preserved during the early stages, myocardial deformation (strain) analysis enables the detection of incipient systolic dysfunction resulting from fibrosis and myofibrillar destruction caused by the direct toxic effects of androgens. Recent studies have demonstrated that both current and former AAS users may exhibit persistent biventricular cardiomyopathy, reinforcing the need for continuous monitoring.

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