scholarly journals Sudden Cardiac Death in Anabolic-Androgenic Steroid Users: A Literature Review

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 587
Author(s):  
Marco Torrisi ◽  
Giuliana Pennisi ◽  
Ilenia Russo ◽  
Francesco Amico ◽  
Massimiliano Esposito ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Anabolic Androgenic Steroids ◽  
Pathophysiological Mechanism ◽  
Anabolic Androgenic Steroid ◽  
Sports Activity ◽  
Androgenic Steroid ◽  
Increased Risk ◽  
Androgenic Steroids

Background and objectives: Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its related precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders, both for aesthetic uses and as performance enhancers to increase muscle growth and lean body mass. When used illicitly they can damage health and cause disorders affecting several functions. Sudden cardiac death (SCD) is the most common medical cause of death in athletes. SCD in athletes has also been associated with the use of performance-enhancing drugs. This review aimed to focus on deaths related to AAS abuse to investigate the cardiac pathophysiological mechanism that underlies this type of death, which still needs to be fully investigated. Materials and Methods: This review was conducted using PubMed Central and Google Scholar databases, until 21 July 2020, using the following key terms: “((Sudden cardiac death) OR (Sudden death)) AND ((androgenic anabolic steroid) OR (androgenic anabolic steroids) OR (anabolic-androgenic steroids) OR (anabolic-androgenic steroid))”. Thirteen articles met the inclusion and exclusion criteria, for a total of 33 reported cases. Results: Of the 33 cases, 31 (93.9%) were males while only 2 (61%) were females. Mean age was 29.79 and, among sportsmen, the most represented sports activity was bodybuilding. In all cases there was a history of AAS abuse or a physical phenotype suggesting AAS use; the total usage period was unspecified in most cases. In 24 cases the results of the toxicological analysis were reported. The most detected AASs were nandrolone, testosterone, and stanozolol. The most frequently reported macroscopic alterations were cardiomegaly and left ventricular hypertrophy, while the histological alterations were foci of fibrosis and necrosis of the myocardial tissue. Conclusions: Four principal mechanisms responsible for SCD have been proposed in AAS abusers: the atherogenic model, the thrombosis model, the model of vasospasm induced by the release of nitric oxide, and the direct myocardial injury model. Hypertrophy, fibrosis, and necrosis represent a substrate for arrhythmias, especially when combined with exercise. Indeed, AAS use has been shown to change physiological cardiac remodeling of athletes to pathophysiological cardiac hypertrophy with an increased risk of life-threatening arrhythmias.

scholarly journals Intrasexual competition as a potential influence on anabolic-androgenic steroid use initiation

2017 ◽  
Vol 24 (9) ◽  
pp. 1210-1220 ◽  
Author(s):  
Marc Harris ◽  
Michael Dunn ◽  
Tina Alwyn
Keyword(s):  
United Kingdom ◽  
Intrasexual Competition ◽  
Anabolic Androgenic Steroids ◽  
Anabolic Androgenic Steroid ◽  
Potential Influence ◽  
Steroid Use ◽  
Novice Group ◽  
Androgenic Steroid ◽  
The United Kingdom ◽  
Androgenic Steroids

An estimated 293,000 people living in the United Kingdom have used anabolic-androgenic steroids. However, there is currently no intervention to reduce usage available in practice or academic circulation throughout the United Kingdom. This study aimed to test a novel hypothesis that increased levels of intrasexual competition may play an important influential role in the use of anabolic-androgenic steroids. Significantly higher levels of intrasexual competition were evident in users compared to non-users but only in the novice group (0–2 years of experience). The research provides evidence for intrasexual competition potentially influencing anabolic-androgenic steroid use but only during the initial stages of usage.

Prevention of sudden cardiac death in persons living with HIV infection

2021 ◽  
Vol 19 ◽  
Author(s):  
Jean-Jacques Monsuez ◽  
Marilucy Lopez-Sublet
Keyword(s):  
Sudden Cardiac Death ◽  
Hiv Infection ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Persons Living With Hiv ◽  
Artery Disease ◽  
Optimized Treatment ◽  
Living With Hiv

: Persons living with HIV infection (PLWH) have been recognized to have an increased risk of sudden cardiac death (SCD). Prevention of this risk should theoretically be included in their long-term management. However, only a few approaches have been proposed to optimize such interventions. Targeting detection of the commonly associated conditions such as coronary artery disease, left ventricular dysfunction, heart failure, QT interval prolongation and ventricular arrhythmias is the first step of this prevention. However, although detection of the risk of SCD is a suitable challenge in PLWH, it remains uncertain whether optimized treatment of the identified risks would unequivocally translate into a decrease in SCD rates.

Abstract 15714: Prediction of Sudden Cardiac Death With Automated High-Throughput Analysis of T-Wave Heterogeneity in Standard 12-Lead Electrocardiogram

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tuomas Kenttä ◽  
Bruce D Nearing ◽  
Kimmo Porthan ◽  
Jani T Tikkanen ◽  
Matti Viitasalo ◽  
...  
Keyword(s):  
At Risk ◽  
Relative Risk ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Adjusted Relative Risk ◽  
T Wave ◽  
Increased Risk ◽  
Patients At Risk

Introduction: Noninvasive identification of patients at risk for sudden cardiac death (SCD) remains a major clinical challenge. Abnormal ventricular repolarization is associated with increased risk of lethal ventricular arrhythmias and SCD. Hypothesis: We investigated the hypothesis that spatial repolarization heterogeneity can identify patients at risk for SCD in general population. Methods: Spatial R-, J- and T-wave heterogeneities (RWH, JWH and TWH, respectively) were automatically analyzed with second central moment technique from standard digital 12-lead ECGs in 5618 adults (46% men; age 50.9±12.5 yrs.) who took part in Health 2000 Study, an epidemiological survey representative of the entire Finnish adult population. During average follow-up of 7.7±1.4 years, a total of 72 SCDs occurred. Thresholds of RWH, JWH and TWH were based on optimal cutoff points from ROC curves. Results: Increased RWH, JWH and TWH (Fig.1) in left precordial leads (V4-V6) were univariately associated with SCD (P<0.001, each). When adjusted with clinical risk markers (age, gender, BMI, systolic blood pressure, cholesterol, heart rate, left ventricular hypertrophy, QRS duration, arterial hypertension, diabetes, coronary heart disease and previous myocardial infarction) JWH and TWH remained as independent predictors of SCD. Increased TWH (≥102μV) was associated with a 1.9-fold adjusted relative risk (95% confidence interval [CI]: 1.2 - 3.1; P=0.011) and increased JWH (≥123μV) with a 2.0-fold adjusted relative risk for SCD (95% CI: 1.2 - 3.3; P=0.004). When both TWH and JWH were above threshold, the adjusted relative risk for SCD was 3.2-fold (95% CI: 1.7 - 6.2; P<0.001). When all heterogeneity measures (RWH, JWH and TWH) were above threshold, the risk for SCD was 3.7-fold (95% CI: 1.6 - 8.6; P=0.003). Conclusions: Automated measurement of spatial J- and T-wave heterogeneity enables analysis of high patient volumes and is able to stratify SCD risk in general population.

scholarly journals Sudden cardiac death in anabolic androgenic steroids abuse: case report and literature review

2019 ◽  
Vol 4 (3) ◽  
pp. 267-273 ◽  
Author(s):  
Ana Isabel Hernández-Guerra ◽  
Javier Tapia ◽  
Luis Manuel Menéndez-Quintanal ◽  
Joaquín S. Lucena
Keyword(s):  
Case Report ◽  
Sudden Cardiac Death ◽  
Literature Review ◽  
Cardiac Death ◽  
Anabolic Androgenic Steroids ◽  
Abuse Case ◽  
Androgenic Steroids

scholarly journals Integrin β1D Deficiency–Mediated RyR2 Dysfunction Contributes to Catecholamine-Sensitive Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 141 (18) ◽  
pp. 1477-1493 ◽  
Author(s):  
Yihui Wang ◽  
Chunyan Li ◽  
Ling Shi ◽  
Xiuyu Chen ◽  
Chen Cui ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Right Ventricular ◽  
Cardiac Death ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Polymorphic Ventricular Tachycardia ◽  
Ventricular Cardiomyopathy ◽  
Open Probability ◽  
Increased Risk

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a hereditary heart disease characterized by fatty infiltration, life-threatening arrhythmias, and increased risk of sudden cardiac death. The guideline for management of ARVC in patients is to improve quality of life by reducing arrhythmic symptoms and to prevent sudden cardiac death. However, the mechanism underlying ARVC-associated cardiac arrhythmias remains poorly understood. Methods: Using protein mass spectrometry analyses, we identified that integrin β1 is downregulated in ARVC hearts without changes to Ca 2+ -handling proteins. As adult cardiomyocytes express only the β1D isoform, we generated a cardiac specific β1D knockout mouse model and performed functional imaging and biochemical analyses to determine the consequences of integrin β1D loss on function in the heart in vivo and in vitro. Results: Integrin β1D deficiency and RyR2 Ser-2030 hyperphosphorylation were detected by Western blotting in left ventricular tissues from patients with ARVC but not in patients with ischemic or hypertrophic cardiomyopathy. Using lipid bilayer patch clamp single channel recordings, we found that purified integrin β1D protein could stabilize RyR2 function by decreasing RyR2 open probability, mean open time, and increasing mean close time. Also, β1D knockout mice exhibited normal cardiac function and morphology but presented with catecholamine-sensitive polymorphic ventricular tachycardia, consistent with increased RyR2 Ser-2030 phosphorylation and aberrant Ca 2+ handling in β1D knockout cardiomyocytes. Mechanistically, we revealed that loss of DSP (desmoplakin) induces integrin β1D deficiency in ARVC mediated through an ERK1/2 (extracellular signal–regulated kinase 1 and 2)–fibronectin–ubiquitin/lysosome pathway. Conclusions: Our data suggest that integrin β1D deficiency represents a novel mechanism underlying the increased risk of ventricular arrhythmias in patients with ARVC.

Abstract 16416: Wide QRS-T Angle on the 12-lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kelvin C Chua ◽  
Carmen Teodorescu ◽  
Audrey Uy-Evanado ◽  
Kyndaron Reinier ◽  
Kumar Narayanan ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Lv Ejection Fraction

Introduction: If we are to improve risk stratification for sudden cardiac death (SCD) we should extend beyond the LV ejection fraction (LVEF). The frontal QRS-T angle has been shown to predict risk of SCD but its value independent of LVEF has not been investigated. Hypothesis: We hypothesize that a wide frontal QRS-T angle predicts SCD independent of LVEF. Methods: Cases of adult sudden cardiac arrest with an available electrocardiogram before the event were identified from a large ongoing population based study of SCD in the Northwest US (population approx. one million). Subjects with a computable frontal QRS-T angle were included. A total of 686 SCD cases (mean age 67.4 years; 95% CI, 52.5 to 82.3 years; 68.2% males; 83.5% whites) met criteria, and were compared to 871 controls with and without coronary artery disease (mean age 66.8 years, 55.3 to 78.3 years; 67.7% males; 90.6% whites) from the same geographical region. Results: The mean frontal QRS-T angle was higher in SCD cases (73.9 degrees; 95% CI, 17.5 to 130.3 degrees, p<0.0001) compared to controls (51.1 degrees; 95% CI 5.0 to 97.2 degrees). Using a cut-off of more than 90 degrees, the frontal QRS-T angle was predictive of SCD, and remained predictive, after adjusting for age, sex, left ventricular ejection fraction (LVEF), prolonged QTc, prolonged QRS duration and baseline comorbidities (OR 1.80; 95% CI, 1.27 to 2.55, p=0.001). On the receiver operating characteristic (ROC) curve, the QRS-T angle demonstrated an area-under-curve (AUC) value of 0.614. Compared to the lowest quartile of QRS-T angle, the highest quartile had nearly a triple increase in the risk of SCD (OR 2.71; 95% CI; 2.03 to 3.60; p<0.0001). Conclusion: A wide QRS-T angle greater than 90 degrees is associated with increased risk of sudden cardiac death independent of left ventricular ejection fraction.

Abstract P105: Small Magnitude of the Heart Movement Due to Respiration is Associated With Sudden Cardiac Death

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Muammar M Kabir ◽  
Elyar Ghafoori ◽  
Jonathan W Waks ◽  
Sunil K Agarwal ◽  
Dan E Arking ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Beta Blockers ◽  
Density Lipoprotein ◽  
Absolute Magnitude ◽  
Left Ventricular ◽  
Small Magnitude ◽  
Increased Risk ◽  
Heart Motion ◽  
The Absolute

Background: Respiration causes heart movement in the chest and proportional change in the heart’s electrical axis. The ECG can be used to measure respiration-related heart motion. The effect of respiration on the ECG is usually considered an artifact. However, it is unknown whether pattern of heart motion due to respiration holds any prognostic value. Method: After excluding those with atrial fibrillation, or atrial or ventricular premature contractions at baseline visit, 14613 ARIC cohort participants (mean age 54.0±5.8 y; 6595 [45.1%] men; 10744 [73.5%] white, 1311 [9.0%] with prevalent cardiovascular disease (CVD)) were included. The digital resting ECG was analyzed using custom Matlab software. The absolute magnitude of the displacement of the heart due to respiration was calculated on X (left-right), Y (up-down), and Z (anterior-posterior) axes. Sudden cardiac death (SCD) and non-coronary heart disease (CHD) death served as competing outcomes in our analysis. Results: In CVD-free participants (as compared to prevalent CVD group) heart moved more on X axis (137±46 vs. 128±47 μV; P<0.0001), and less on Z axis (123±52 vs. 127±60 μV; P=0.05). During a median follow-up of 14 years 278 SCDs (96 in CVD group) and 1619 non-CHD (279 in CVD group) deaths occurred. In competing risk analysis that adjusted for age, gender, race, history of myocardial infarction, CHD, heart failure, systolic blood pressure, anti-hypertensive medications, diabetes, smoking, total cholesterol, high density lipoprotein, level of physical activity, use of beta-blockers, left ventricular hypertrophy on ECG and QRS duration, the absolute magnitude of respiration-related heart movement on X axis (SHR 0.74; 95%CI 0.59-0.93; P=0.009) and Z axis (SHR 1.19; 95%CI 1.01-1.41; P=0.042) associated with SCD (but not with non-CHD death) in CVD group, but not in CVD-free participants. Conclusion: Greater respiration-caused heart motion on Z axis and smaller - on X axis likely reflects cardiomegaly and is associated with increased risk of SCD in patients with CVD.

Association of isolated T inversion and sudden cardiac death – etiology and gender differences

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A.E Haukilahti ◽  
L Holmstrom ◽  
J Vahatalo ◽  
T.V Kentta ◽  
L Pakanen ◽  
...  
Keyword(s):  
Gender Differences ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Common Finding ◽  
Control Group ◽  
Funding Source ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Inferolateral T wave inversion has been associated with increased risk of mortality and sudden cardiac death (SCD) in general population. However, the association between isolated T inversion and SCD is still unclear. Purpose The purpose of this study was to examine whether isolated T inversion associates with SCD, and find out possible gender differences. Methods FinGesture Study has systematically collected clinical data and medico-legal autopsy data from 5,869 consecutive SCD victims (mean age 64.9±12.4 yrs.) in Northern of Finland between years 1998 and 2017. Previously recorded electrocardiograms (ECG) were available and analyzed in 1,101 subjects. The control group consisted of 7,217 subjects representative of Finnish general population (mean age 51.5±12.4 yrs.). T inversion was interpreted isolated if there was at least two T inversions ≥−0.1 mV in at least two contiguous leads, and there were no ECG signs of left ventricular hypertrophy (LVH) defined by Sokolow-Lyon criteria or bunchle brand block (BBB) attached to it. Results In a current study, isolated T inversion was more common finding among SCD victims compared to general population: isolated T inversion in any leads 10.9% vs. 0.9% (SCD vs. general population, p&lt;0.001), laterally 7.7% vs. 0.1% (p&lt;0.001), inferiorly 3.2% vs. 0.5% (p&lt;0.001) and anteriorly 2.9% vs. 0.4% (p&lt;0.001). Particularly, isolated T inversion seemed to assoaciate with ischemic SCD taking into account that 61.5% of the total isolated T inversions were seen in ischemic SCD victims (p=0.018). In addition, 62.1% of the inferior isolated T inversions (p=0.023) and 61.7% of the lateral isolated T inversions (p=0.031) were in ischemic SCD victims versus 37.9% and 38.3% in non-ischemic SCD victims, respectively. The prevalence of isolated T inversion in any lead was also higher among male SCD victims compared to female victims (12.8% vs. 8.2%, p&lt;0.001, respectively). There was no statistically significant difference in the prevalence of LVH and strain changes between the populations. Among bundle branch blocks left BBB was predictably more typical in SCD victims (5.8% vs. 0.5%, p&lt;0.001). Conclusion We noticed an association between isolated T inversion and SCD. The association was most prominent in males and in those with ischemic etiology of SCD. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research

Sudden cardiac death: epidemiology and prevention

2015 ◽  
Author(s):  
Hans-Richard Arntz
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Industrialized Countries ◽  
Pharmacological Prevention ◽  
Increased Risk ◽  
Genetically Determined

Even if sudden cardiac death is considered to be the most frequent cause of death in adults in industrialized countries, its incidence varies widely, depending on the definition and the source and quality of underlying data. It is estimated that about 70-80% of cases are due to coronary heart disease. The remaining 20% are attributable to a wide variety of inborn, genetically determined or acquired diseases, including a small group with hitherto undefined background. Prevention primarily encompasses the treatment of cardiovascular risk factors to avoid manifestations of coronary heart disease. Furthermore, preventive strategies are targeted to define groups of patients with an increased risk for sudden cardiac death or individuals at risk in specific populations, e.g. competitive athletes. A major target group are patients with impaired left ventricular function, preferentially due to myocardial infarction. These patients, and some less clearly defined patient groups with non-ischaemic cardiomyopathy and heart failure, may benefit from the insertion of an implantable cardioverter-defibrillator. With regard to pharmacological prevention, treatment of the underlying condition is the mainstay, since no antiarrhythmic substance-with the exemption of beta-blockers in some situations-has shown to be of efficacy.

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