Prolonged androgenic anabolic steroid (AAS) induced QT interval shortening: a suitable screening tool? Nicholas Sculthorpe, a * Lee Taylor b and Fergal M. Grace a Androgenic anabolic steroid (AAS) abuse is associated with changes in cardiac electrophysiology. Recently heart rate corrected QT interval (QTc) has been suggested as a method of screening for AAS use in athletes despite conflicting reports. This study aimed to further investigate the effect of AAS on QTc in a cohort of long-term AAS users in whom the affects may be more pronounced. Using a cross-sectional cohort design with AAS using resistance trained athletes (AS n = 15) and a group of non-AAS using resis- tance trained, age matched controls (C n = 15). AS had a long history of AAS use (18 ± 2 yrs) and AS and C both had >19 years of resistance training. Participants underwent a resting electrocardiogram (ECG), from which, the QTc interval was calculated using the Bazett formula. The main outcome measure was significant differences in mean corrected QTc between groups. A secondary outcome was to calculate a QTc that best differentiated between C and AS. Results indicated that QTc was shorter in AS than in C (382.0 ± 21.01 ms versus 409 ± 18.77 ms for AS and C respectively p < 0.001). Chi squared analyses revealed a greater incidence of QTc < 380 ms in AS versus C p < 0.01, specificity 93% sensitivity 60%). In conclusion these results supports previous findings that AAS use causes a reduction in QTc, however, the specificity and sensitivity in our sample is lower than reported previously and precludes use as a screening tool. Copyright © 2015 John Wiley & Sons, Ltd. Keywords: doping; screening; electrophysiology Introduction The prevalence of doping in athletics has been estimated at 14–39% [1] however, the majority of AAS use is for recreational or aesthetic purposes and is associated with numerous negative health consequences. [2] Recent evidence suggests AAS effects electrophysiology, including increased risk of cardiac electro- physiological instability. [3] However, their effect on QT interval duration remains contentious. Bigi et al. reported [4] that AAS use reduces corrected QT interval (QTc) and may be used to identify users, a concept supported in a consensus statement on ECG interpretation in athletes. [5] Schwartz et al. [6] have also reported QTc shortening following androgen administration in elderly men. Conversely, others have reported that AAS abuse has no effect on QTc [7] or their use is associated with a length- ening of QT interval. [8] Given that longer durations of abuse (>8 years) have been asso- ciated with shorter QTc intervals [4] we hypothesized that prolonged AAS use (>20 yrs) would exhibit greater QT shortening. We further hypothesized that the frequency with which QT intervals fell below the suggested screening threshold [4,5] would be greater following prolonged AAS use. Method Following university ethical approval, subjects provided written in- formed consent to participate in the study. Participants were a group consisting of amateur and professional bodybuilders using high dose anabolic steroids (AS n = 15) and age-matched resistance trained controls (CON n = 15). AS trained for 3–5 days per week using heavy resistance exercise and had been engaged in com- bined AAS use and resistance training for >20 years (23 ± 2 years). AAS use was confirmed by urinalysis at an International Olympic Committee (IOC) accredited laboratory. CON took part in regular bodybuilding exercise (3–5 days.week À1 ) and had done for >15 years (19 ± 4 years). Following 10 min of supine rest, subjects underwent a resting 12 lead ECG, (CardioVit AT60, Schiller AG, Baar, Switzerland). Measure- ment was performed on traces recorded at a paper speed of 50 mm.s À1 , subsequently digitized and QT intervals measured man- ually using lead II, from the beginning of Q wave to the end of the T wave (defined as its return to the TP baseline). If the end of the T wave could not be identified in lead II, lead V3 or V5 was used. QT intervals were corrected using the Bazett formula. [9] Statistical analysis Data were analyzed using SPSS v20.0. Group differences were com- pared using independent t-tests. A Chi-squared test was employed to compare frequency of short QTc intervals between groups. Alpha of P < 0.05 was used to indicate statistical significance. * Correspondence to: Nicholas Sculthorpe, Institute of Clinical Exercise and Health Science, School of Science and Sport, University of the West of Scotland, Hamilton, Scotland ML3 0BJ, UK. E-mail: Nicholas.sculthorpe@uws.ac.uk a Institute of Clinical Exercise and Health Science, School of Science and Sport, University of the West of Scotland, Hamilton, Scotland ML3 0BJ, UK b Institute of Sport and Physical Activity Research, University of Bedfordshire, Bedford MK41 9EA, UK Drug Test. Analysis 2016,8, 120–122 Copyright © 2015 John Wiley & Sons, Ltd. Short communication Drug Testing and Analysis Received: 27 March 2015 Revised: 29 April 2015 Accepted: 20 May 2015 Published online in Wiley Online Library: 8 June 2015 (www.drugtestinganalysis.com) DOI 10.1002/dta.1826 120