Question: Its my understanding that Chest XRays are a very poor indicator of true cardiomegaly, do you agree with that ?

The diagnosis of AAS-induced Cardiomyopathy

I have decided to start posting questions that I have askedĀ Scott Howell, IMO the World Leading AAS Harm Reduction Specialist on my website..

Yes I will post these in the ” Free Area” that is only fair…

My reasoning is so these are not ” lost to time” on a Facebook Thread

This subject is

The diagnosis of AAS-induced cardiomyopathy

Multiple reports of exogenous AAS have been linked with adverse cardiovascular outcome in humans, and long-term testosterone use may lead to hypertension and stroke, cardiac diastolic and systolic dysfunction, coronary artery disease, arrhythmias, and sudden death.

The diagnosis of AAS-induced cardiomyopathy requires a thorough history and physical, and exclusion of other common causes of cardiomyopathy.

But first we need to ascertain if there is an indication of Cardiomyopathy regardless of the underlying cause..

Victors Question:

Scott, Its my understanding that Chest XRays are a very poor indicator of true cardiomegaly, do you agree with that ?

The reason for the question stems from clients that ask if getting a Chest Xray is acceptable for annual health check over Echo

” Fifty-five were reported to have cardiomegaly on echo, of which 33 (60{4810c8228756a9189e64fcffe2b64504834fd1a9aa1761a0e9a85eac56097be8}) did not have cardiomegaly identified on CXR.

Sensitivity of CXR to identify cardiomegaly was 40{4810c8228756a9189e64fcffe2b64504834fd1a9aa1761a0e9a85eac56097be8} and specificity was 91{4810c8228756a9189e64fcffe2b64504834fd1a9aa1761a0e9a85eac56097be8} with a positive predictive value of 56{4810c8228756a9189e64fcffe2b64504834fd1a9aa1761a0e9a85eac56097be8} and negative predictive value of 84{4810c8228756a9189e64fcffe2b64504834fd1a9aa1761a0e9a85eac56097be8}. ”

So its a fairly poor indicator here, right ?

Answer: Scott Howell

Yes, radiographs are not ideal for diagnosing or quantifying cardiomegaly.

I suggest transthoracic echocardiogram ideally every year to track the rate of change in heart morphology and function. It is very problematic to use radiography to establish heart morphology. The cardiothoracic ratio is sometimes used with radiographs but it is not ideal by any stretch.

However, if transthoracic echo is used it is important that the same technician run the machine each time and that they are aware of the errors with indexing equations when BMI is skewed by lean body mass.

The BMI for a bodybuilder will be considered obese even though they are lean.

The body surface area ^2 parameter is another input that needs careful attention. Most do not even think about it even cardiologists but it is very important that they know the estimates will be off, depending on which index is chosen if close attention isn’t given to choosing the right index or offsetting an equation.

Regardless, even if the wrong indexing parameters are input, if they are held consistently year after year, anyone can monitor the rate of change of morphology.

I hope this helps.

Thank you Scott as always