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Updated: Jan 17, 2026

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

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Evaluating ECG Criteria for Diagnosing Left Ventricular Hypertrophy in Anabolic-Androgenic Steroid Users

Rang Abdullah1, Astrid Bjørnebekk2, Lisa E Hauger3

  • 1University of Oslo, Oslo, Norway; ProCardio Center for Research Based Innovation, Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

JACC. Advances
|January 14, 2026
PubMed

Insights

Electrocardiography (ECG) is insufficient for detecting left ventricular hypertrophy (LVH) in anabolic-androgenic steroid (AAS) users. Echocardiography is recommended for early detection of LVH and associated cardiac dysfunction in this high-risk population.

Area of Science:

  • Cardiology
  • Sports Medicine
  • Pharmacology

Background:

  • Anabolic-androgenic steroid (AAS) users are a high-risk cardiovascular group.
  • Left ventricular hypertrophy (LVH) is a common complication in AAS users.
  • The effectiveness of electrocardiography (ECG) for detecting LVH in this population is unknown.

Purpose of the Study:

  • To evaluate the diagnostic performance of six common ECG-LVH criteria.
  • To identify LVH using echocardiography as the reference standard in long-term AAS users.

Main Methods:

  • 100 male AAS users were studied (32 with echocardiographic LVH, 68 without).
  • Six ECG-LVH criteria were assessed for sensitivity, specificity, and predictive values.
  • Echocardiography was used as the gold standard; LV systolic function was evaluated via ejection fraction and global longitudinal strain.

Main Results:

  • AAS users with LVH showed more significant LV systolic dysfunction (lower ejection fraction, impaired global longitudinal strain).
  • Peguero-Lo Presti (sensitivity 31%, specificity 88%) and Romhilt-Estes (sensitivity 34%, specificity 85%) showed the best performance among ECG criteria.
  • Most cases of echocardiographic LVH (66-69%) were missed by ECG criteria.

Conclusions:

  • ECG is inadequate for detecting echocardiographic LVH in AAS users.
  • Routine specialist evaluations, including echocardiography, are crucial for early detection of LVH and dysfunction in long-term AAS users.
Abstract

Keywords:
ECGanabolic-androgenic steroidsleft ventricular hypertrophy

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