Key result
Standard ECG criteria miss echo-confirmed LVH in anabolic steroid users, showing only ~31% sensitivity.
Why the study?
LVH is a common complication in high-risk anabolic-androgenic steroid users, yet the utility of ECG criteria for detecting LVH remains unexplored.
Does 12-lead ECG accurately detect echocardiographic left ventricular hypertrophy in male anabolic-androgenic steroid users?
Cross-Sectional (n=100)
Observer-blinded
No
Does 12-lead ECG accurately detect echocardiographic left ventricular hypertrophy in male anabolic-androgenic steroid users?
Routine 12-lead ECG criteria possess insufficient sensitivity to reliably detect left ventricular hypertrophy in anabolic-androgenic steroid users, indicating that specialized echocardiographic screening is necessary for accurate risk stratification.
Answers are grounded in this paper and cite their sources.
ECG criteria warrant caution for LVH screening in AAS users; leaves open whether echocardiography improves risk stratification.
BACKGROUND: Anabolic-androgenic steroid (AAS) users represent a high-risk cardiovascular population. Left ventricular (LV) hypertrophy (LVH) is a common complication, yet the utility of electrocardiographic (ECG) criteria for detecting LVH remains unexplored. OBJECTIVES: The objective of the study was to evaluate the diagnostic performance of six commonly used ECG-LVH criteria in identifying echocardiographic LVH among long-term AAS users. METHODS: We included 100 male AAS users, 32 with echocardiographic LVH and 68 without. Six ECG-LVH criteria (Sokolow-Lyon, Modified Sokolow-Lyon, Cornell voltage, Cornell product, Peguero-Lo Presti, and Romhilt-Estes) were assessed for sensitivity, specificity, and predictive values, using echocardiography as the reference standard. LV systolic function was evaluated by LV ejection fraction and global longitudinal strain. RESULTS: AAS users with echocardiographic LVH exhibited more pronounced LV systolic dysfunction than those without, as shown by a higher number of individuals with LV ejection fraction ≤40% (7 [23%] vs 4 [6%], P = 0.02) and more impaired LV global longitudinal strain (-14.7% ± 2.7% vs -16.5% ± 2.2%, P = 0.002). Among voltage-based indices, Peguero-Lo Presti provided the best balance between sensitivity (31%) and specificity (88%). The point-based Romhilt-Estes using a cutoff of 5 offered comparable performance, with a sensitivity of 34% and specificity of 85%. However, most AAS users with echocardiographic LVH were not identified by ECG, with 69% remaining undetected by Peguero-Lo-Presti and 66% by Romhilt-Estes. CONCLUSIONS: ECG was insufficient for identifying echocardiographic LVH in AAS users who represent a high-risk cardiovascular population. Routine specialist evaluations, including echocardiography, should be considered for long-term AAS users to facilitate early detection of LVH and associated dysfunctions.
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Abdullah et al. (2026) conducted a cross-sectional in Left ventricular hypertrophy in anabolic-androgenic steroid users (n=100). Electrocardiographic (ECG) criteria for left ventricular hypertrophy vs. Echocardiography (reference standard) was evaluated on Predictive performance of the Peguero-Lo Presti ECG criterion for echocardiographic left ventricular hypertrophy (AUC 0.70, 95% CI 0.60-0.81, p=0.001). Commonly used ECG criteria, including the Peguero-Lo Presti index, demonstrated poor sensitivity (31%) and were insufficient for identifying echocardiographic left ventricular hypertrophy in male anabolic-androgenic steroid users.
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