Calibrated Integrated Backscatter Is Associated With Increased Left Ventricular Concentricity and Left Atrial Stiffness in Resistance Trained Individuals Using Anabolic-Androgenic Steroids

Place, F ORCID: 0009-0005-5422-2738, Hamilton, CA, Carpenter, H, Howard, LJ ORCID: 0009-0006-2152-8877, Morrison, BN, Chester, N ORCID: 0000-0001-8791-5040, Cooper, RM ORCID: 0000-0001-7482-828X, Stansfield, BN, George, KP ORCID: 0000-0002-5119-6651, Angell, P and Oxborough, D ORCID: 0000-0002-1334-3286 (2026) Calibrated Integrated Backscatter Is Associated With Increased Left Ventricular Concentricity and Left Atrial Stiffness in Resistance Trained Individuals Using Anabolic-Androgenic Steroids. Echocardiography, 43 (4). ISSN 0742-2822

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Abstract

Purpose
The use of Anabolic-Androgenic Steroids (AAS) is well documented in resistance trained individuals, despite reports of myocardial inflammation and fibrosis. Calibrated integrated backscatter (ciB) is an echocardiographic technique to measure ultrasonic reflectivity of the left ventricular (LV) myocardium and is a marker for tissue characterization. This study assessed ciB in both AAS using and non-using resistance trained individuals and documented any relationship to LV and left atrial (LA) structure and function.

Methods
Male (n = 120) and female (n = 21) resistance trained individuals (age 30 ± 7 years); current (CU; n = 95) and non-users (NU; n = 46) of AAS were recruited. Comprehensive echocardiography with strain imaging was performed. ciB was measured from a parasternal long axis and LA stiffness index (E/E′/LA reservoir strain) and left atrioventricular coupling index (LA end-diastolic volume/LV end-diastolic volume) were calculated.

Results
ciB was significantly higher in CU (–19.54 ± 4.63) than NU (–20.88 ± 3.94, p = 0.047). A significant positive correlation was observed between ciB and LV mass index (rs(139) = 0.318, p < 0.001), E/E′ (r(138) = 0.169, p = 0.043), LA conduit strain (r(135) = –0.174, p = 0.043), LA stiffness index (rs(134) = 0.246, p = 0.004), and left atrioventricular coupling index (r(134) = 0.241, p = 0.005). ciB was not associated with any LV systolic functional parameter (global longitudinal strain or ejection fraction).

Conclusions
Resistance trained individuals using AAS have significantly higher ciB than non-users, suggesting differential myocardial tissue characteristics within this population. The presence of higher levels of ciB was significantly associated with LV geometry and LV diastolic function which may indicate a role of ciB in identifying early cardiac risk in this population.

Item Type:	Article
Uncontrolled Keywords:	anabolic‐androgenic steroids; calibrated integrated backscatter; cardiac remodeling; echocardiography; Humans; Male; Female; Adult; Heart Ventricles; Heart Atria; Echocardiography; Resistance Training; Reproducibility of Results; Testosterone Congeners; Anabolic Agents; 32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; Cardiovascular; Heart Disease; Biomedical Imaging; Clinical Research; Cardiovascular; Humans; Male; Female; Adult; Heart Ventricles; Heart Atria; Echocardiography; Resistance Training; Reproducibility of Results; Testosterone Congeners; Anabolic Agents; 1102 Cardiorespiratory Medicine and Haematology; Cardiovascular System & Hematology; 3201 Cardiovascular medicine and haematology
Subjects:	Q Science > QP Physiology R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Wiley
Date of acceptance:	26 March 2026
Date of first compliant Open Access:	16 April 2026
Date Deposited:	16 Apr 2026 10:43
Last Modified:	16 Apr 2026 10:43
DOI or ID number:	10.1111/echo.70454
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28384

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