Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification

Abstract

Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.

Interrelation among exercise training, cardiac hypertrophy, and tissue kallikrein-kinin system in athlete and non-athlete women

“…The homoscedasticity of variances was confirmed by Levene’s test and two-way ANOVA was performed to identify differences between the groups and among the sampling time points. 1 , 2 , 3 Significant difference ( P < 0.05) in comparison with T1, T2, and T3 in the same group, respectively. * Significant difference in comparison with the non-athlete group at the same time point.…”

“… 2 Globally, cardiac hypertrophy is divided into two major categories: concentric and eccentric. 3 Concentric geometry refers to hypertrophies without ventricular dilation and results from pressure overload in the left ventricle. On the other side, eccentric architecture represents patterns with a dilated chamber as a consequence of pregnancy, repetitive exercise training, and mitral regurgitation.…”

“…4 Regarding its validity, noninvasiveness, and ease of access, echocardiography is the method of choice for the detection of cardiac hypertrophy in the clinical setting. 2 , 3 From the viewpoint of echocardiographic parameters, concentric hypertrophy is manifested through a normal ventricular end-diastolic diameter (LVEDD) concomitant with an increase in the left ventricle mass (LVM). On the contrary, eccentric hypertrophy is recognized by an increase in both LVEDD and LVM.…”

Should We Limit Antiarrhythmic Drug Choice in Patients With Left Ventricular Hypertrophy?

“…Fortunately, most patients treated with antiarrhythmic drugs with LVH by echocardiographic criteria have LV wall thicknesses less than 1.4 cm. The complexity of the defining LVH by echocardiographic criteria has been well-documented and can include LV mass measurements in addition to LV wall thickness (13). To complicate things further, LV remodeling can occur.…”

Should we limit antiarrhythmic drug choice in patients with left ventricular hypertrophy?

“…These data are consistent with Abraham et al 10 include LV mass measurements in addition to LV wall thickness. 13 To complicate things further, LV remodeling can occur. LVH can be present with or without coronary artery disease, electrolyte disturbances, and clinical heart failure all of which increase the risk of ventricular arrhythmias.…”