Image and performance enhancing drugs (IPEDs) are commonly used in resistance trained (RT) individuals and negatively impact left ventricular (LV) structure and function. Few studies have investigated the impact of IPEDs on atrial structure and function with no previous studies investigating bi-atrial strain. Additionally, the impact of current use vs. past use of IPEDs is unclear. Utilising a cross-sectional design, male (n = 81) and female (n = 15) RT individuals were grouped based on IPED user status: current (n = 57), past (n = 19) and non-users (n = 20). Participants completed IPED questionnaires, anthropometrical measurements, electrocardiography, and transthoracic echocardiography with strain imaging. Structural cardiac data was allometrically scaled to body surface area (BSA) according to laws of geometric similarity. Body mass and BSA were greater in current users than past and non-users of IPEDs (p < 0.01). Absolute left atrial (LA) volume (60 ± 17 vs 46 ± 12, p = 0.001) and right atrial (RA) area (19 ± 4 vs 15 ± 3, p < 0.001) were greater in current users than non-users but this difference was lost following scaling (p > 0.05). Left atrial reservoir (p = 0.008, p < 0.001) and conduit (p < 0.001, p < 0.001) strain were lower in current users than past and non-users (conduit: current = 22 ± 6, past = 29 ± 9 and non-users = 31 ± 7 and reservoir: current = 33 ± 8, past = 39 ± 8, non-users = 42 ± 8). Right atrial reservoir (p = 0.015) and conduit (p = 0.007) strain were lower in current than non-users (conduit: current = 25 ± 8, non-users = 33 ± 10 and reservoir: current = 36 ± 10, non-users = 44 ± 13). Current users showed reduced LV diastolic function (A wave: p = 0.022, p = 0.049 and E/A ratio: p = 0.039, p < 0.001) and higher LA stiffness (p = 0.001, p < 0.001) than past and non-users (A wave: current = 0.54 ± 0.1, past = 0.46 ± 0.1, non-users = 0.47 ± 0.09 and E/A ratio: current = 1.5 ± 0.5, past = 1.8 ± 0.4, non-users = 1.9 ± 0.4, LA stiffness: current = 0.21 ± 0.7, past = 0.15 ± 0.04, non-users = 0.15 ± 0.07). Resistance trained individuals using IPEDs have bi-atrial enlargement that normalises with allometric scaling, suggesting that increased size is, in part, associated with increased body size. The lower LA and RA reservoir and conduit strain and greater absolute bi-atrial structural parameters in current than non-users of IPEDs suggests pathological adaptation with IPED use, although the similarity in these parameters between past and non-users suggests reversibility of pathological changes with withdrawal.

The relationship between electrocardiographic based QRS fragmentation (fQRS) and physiological cardiac adaptation is not fully understood. We aimed to determine the prevalence of fQRS in elite male and female cyclists, and relationship between fQRS and cardiac structure and function. 181 Elite international cyclists underwent their national cycling team's pre-participation cardiac screening. This included a resting 12‑lead electrocardiogram and transthoracic echocardiogram. Fragmented QRS was defined as an additional notch >1 mm deep from the peak of the wave within the QRS complex in any lead. We excluded RSR' or RSR'S' patterns in V1-2 to differentiate from bundle branch block. Fragmented QRS was observed in 73 (41 %) of the cyclists. The most common lead was V1, followed by lead III, aVL and aVF. Of those cyclists with fQRS it was observed in just one lead in 38 cyclists (52 %), two leads in 22 cyclists (30 %) and ≥ three leads in 13 cyclists (18 %). Cyclists with fQRS demonstrated greater left ventricular (LV) diastolic diameter index (p = 0.008), mean wall thickness (p < 0.001), LV mass index (p = 0.001), proximal right ventricular (RV) outflow diameter (RVOT_PLAX) index (p = 0.040), distal RVOT₂ index (p < 0.001), RV systolic area index (p = 0.005), and RV:LV ratio (p = 0.008). In addition, cyclists with fQRS had significantly lower RV fractional area change (p = 0.002). Fragmented QRS in athletes is associated with indices of physiological LV and RV adaptation. In isolation, fQRS may not raise concern or initiate any further onward investigations.

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 (r _s (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 (r _s (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.

Background: Elite cycling can be dichotomised into road (endurance cycling) and track (sprint cycling) events that are associated with different training components and athlete physiology. Evidence of disproportionate right ventricular (RV) remodelling in endurance athletes places importance on defining physiological and athletic phenotypes. Therefore, the elite cyclist serves as an ideal model to study training-specific adaptations in the right heart. Methods: One hundred and eighty-six (110 males and 76 females) elite international-level cyclists (mean age 23 ± 5 years) were grouped by discipline (endurance cycling and sprint cycling) and sex (male cyclists and female cyclists). RV and right atrial (RA) structure and function was assessed with 2D, tissue Doppler, and strain echocardiography. Structural data were scaled allometrically to body size. Group comparisons were made with a two-way ANOVA. Results: Significantly larger absolute and scaled RV and RA structural values were seen in male and endurance cyclists (RV end diastolic area index: male endurance 14 ± 2 cm²/m², male sprint 13 ± 2 cm²/m²) than female and sprint cyclists (female endurance 13 ± 2 cm²/m², female sprint 11 ± 2 cm²/m²), respectively. Endurance training exposure was significantly correlated to structural parameters (RA area index: r = 0.53; p < 0.001). Sex and discipline showed significant impact on resting RV function with reduced RV strain values in male and endurance cyclists (RV basal strain: male endurance −17.5 ± 4.0%, male sprint −19.4 ± 4.6%) compared to female and sprint cyclists (female endurance −19.9 ± 3.9%, female sprint −22.1 ± 5.1%), respectively. There were no significant correlations between training exposure and resting RV function. Conclusions: Athlete sex and cycling discipline exert significant effects on RV and RA structure and function in elite cyclists. The strong correlations observed between endurance training exposure and right heart structure emphasise the importance of consideration of sporting discipline in elite athletes.

Background: Structural and functional adaptation of the heart to chronic exercise is dependent on multiple factors, including the volume and type of training, and has direct implications for pre-participation cardiac screening (PPCS). Sailing is a unique multi-training modality sport with limited prior description of cardiac adaptation to training. The aims of this study are (1) to describe electrocardiogram (ECG) changes in sailors, informing PPCS guidelines; (2) to assess structural and functional cardiac changes in sailors; and (3) to examine sex- or discipline-specific cardiac adaptations in sailors. Methods: Seventy elite sailors (33 females) underwent standard ECG and echocardiography. Echocardiographic data were compared to population norms and analysed by sex and sailing discipline based on training type: isometric (IG), pumping (PG), and movement (MG). Results: One sailor presented with abnormal ECG findings (T wave inversion) which warranted further investigation. Primary training-related ECG changes noted were early repolarisation (24%) and sinus bradycardia (30%). The left ventricular volume index was dilated in 18% of all sailors compared to reference values, with similar findings noted on right ventricular parameters for 22% of the study population, although in males only. The impact of predominant training stimulus (IG, PG, MG) did not mediate differences in the structure of any cardiac chambers (p > 0.05). Ejection fraction was lower in the PG (Δ4%, p ≤ 0.001), whereas global longitudinal strain was higher (Δ2%, p = 0.02) compared to MG and IG. Conclusions: Elite-level sailors present with electrical and structural cardiac phenotypes associated with exercise adaptation, with dilation of both left- and right-sided chambers. These data should be considered when interpreting results of PPCS in male and female sailors from different, specific disciplines.