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Dr. Scharhag and colleagues raise the important point that steroid use among the athletes may have affected echocardiographic features of presumably healthy elite football players. Anabolic steroids are commonly used to enhance athletic performance and muscle development and may have deleterious effects. Hypertension, ventricular remodeling, myocardial ischemia, and sudden cardiac death have each been temporally and causally associated with anabolic steroid use in humans (1). However, studies examining the effects of anabolic steroids on myocardial structures have not been consistent, and the topic remains controversial (2,3). Surveys of U.S. football players at the high school level suggest that more than 6% had used anabolic steroids (4). However, even though we were unable either to question the participants or to perform blood tests for steroid use as part of our study, National Football League (NFL) players are subject to year-round testing. Therefore, it would be very difficult for them to use these substances.
The number of subjects with thickened ventricular walls is correctly shown in the histogram of Figure 2 of our report. Actually, 30% (47 of 156 subjects) had a wall thickness ≥13 mm. The statement in the Discussion section of our report that “six percent of the football players in our series had a wall thickness in the borderline range of >13 mm” was in error. Six percent had a wall thickness of >14 mm as stated in the caption of Figure 2. The incidence of intraventicular septal thickness of more than 13 mm (14 to 16 mm) was 11% (17 of 156 subjects) as stated in the Results section. The incidence of either the intraventricular septal wall or left ventricular free wall being more than 13 mm was actually higher (13%; 20 of 156 subjects).
The findings presented in our study demonstrate the chamber size, wall thickness, and ejection fraction of elite professional American football players in the NFL. Because both the size and the types of physical effort of these players are different from those of bodybuilders, rowers, canoists, or cyclists, we believe these observations will be useful in separating physiologic adaptations from pathologic findings when evaluating such players.
- American College of Cardiology Foundation