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

Pugh, F and Hamilton, C and Carpenter, H and Howard, LJ and Morrison, BN and Chester, Neil and Cooper, R and Stansfield, B and George, KP and Angell, Peter J. and Oxborough, D (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. 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
Additional Information and Comments:	© 2026 The Author(s). This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Faculty / Department:	Faculty of Human and Digital Sciences > School of Health and Sport Sciences
Depositing User:	Peter Angell
Date Deposited:	01 May 2026 14:06
Last Modified:	01 May 2026 14:06
URI:	https://hira.hope.ac.uk/id/eprint/4887

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