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Left Ventricular Hypertrophy - Role Of Echocardiography In Its Classification

Echocardiography is the most well-validated, non-invasive, and widely used method for assessing left ventricular hypertrophy.

Alternative technologies, notably magnetic resonance imaging, are expensive and pose practical difficulties in large-scale clinical use.

Left ventricular hypertrophy should be evaluated with the left ventricular remodeling evaluation to encompass various physiological and pathological circumstances.

The widely accepted 2-group categorization of left ventricular hypertrophy solely utilizes left ventricular mass estimate and relative wall thickness as identifying factors.

However, understanding the 2-group patterns offers more predictive information beyond left ventricular hypertrophy. On the other hand, left ventricular enlargement has independent prognostic usefulness beyond left ventricular mass for incident heart failure.

As a result, a 4-group left ventricular hypertrophy classification based on left ventricular mass, left ventricular volume and relative wall thickness has been proposed.

This new left ventricular hypertrophy classification is distinguished by unique changes in heart function, enabling doctors to differentiate between diverse left ventricular hemodynamic stress responses in various cardiovascular conditions.

The new 4-group left ventricular hypertrophy categorization offers the benefit of improving the left ventricular hypertrophy diagnostic method and has the potential to enhance the identification of maladaptive reactions that need focused treatment.

What Is Left Ventricular Hypertrophy?

Left ventricular hypertrophy, or LVH, refers to a thicker left pumping chamber of the heart that may not be pumping correctly.

Aortic stenosis and high blood pressure may both overwork the heart muscle. In reaction to this pressure overload, the inner walls of the heart may thicken.

These thicker walls might weaken, stiffen, and lose elasticity in the left ventricle, preventing healthy blood flow.

Left Ventricular Hypertrophy Epidemiology

Left ventricular hypertrophy was detected often in the overall echocardiographic population using the indexation techniques and partition values presently provided by the American society of echocardiography/European association of cardiovascular imaging (42% of subjects).

The most prevalent pattern produced concentric left ventricular hypertrophy (16%). However, the incidence of the left ventricular hypertrophy pattern varied depending on the population analyzed.

Indeed, in patients with isolated severe aortic stenosis, concentric left ventricular hypertrophy (57.3%) was the most common remodeling type, followed by mixed (18.9%) and dilated left ventricular hypertrophy (8.4%).

Nonetheless, the incidence of remodeling patterns varied across symptomatic and asymptomatic individuals.

Human heart anatomy showing blood flow direction during heart pumping
Human heart anatomy showing blood flow direction during heart pumping

Left Ventricular Hypertrophy Classification System

From a pathological standpoint, the four left ventricular hypertrophy remodeling patterns must be accompanied by corresponding hemodynamic and functional characteristics.

Patients with mixed left ventricular hypertrophy showed lower ejection fraction, NT-pro-BNP, and BNP levels than those with dilated left ventricular hypertrophy.

Compared to those without left ventricular hypertrophy, those with ambiguous left ventricular hypertrophy had no increase in cardiac stress indicators.

Eccentric left ventricular hypertrophy was related to the poorest hemodynamic profile. Diastolic dysfunction was seen in 43.5% of people with dilated left ventricular hypertrophy, 36% with concentric left ventricular hypertrophy, and 8.2% in patients without left ventricular hypertrophy.

The 4-group categorization was linked to left ventricular mechanics in a group of hypertension individuals.

The suggested new left ventricular hypertrophy subcategories seem to be more than just descriptors of left ventricular shape but also an intrinsic component of metrics representing systolic characteristics.

Clinical Outcomes Of 4-Group Left Ventricular Hypertrophy Classification

In most investigations, the 4-group left ventricular hypertrophy categorization system was a reliable predictor of unfavorable cardiovascular events.

The Losartan Intervention for Endpoint Reduction Echocardiography substudy was the first to employ widely accessible echocardiographic measures to replicate cardiac magnetic resonance findings in 939 hypertension patients treated for 4.8 years.

Individuals with dilated, concentric, and mixed left ventricular hypertrophy had a higher risk of all-cause death.

In comparison to patients without left ventricular hypertrophy, indeterminate left ventricular hypertrophy was not linked with an elevated relative risk.

Patients with dilated, concentric, or mixed left ventricular hypertrophy had a higher risk of all-cause death than those without left ventricular hypertrophy.

Dilated left ventricular hypertrophy is related to cardiovascular mortality, acute heart failure hospitalization valve replacement in 370 individuals with chronic aortic regurgitation.

Participants with uncertain left ventricular hypertrophy had no higher risk of main primary and secondary outcomes.

However, only baseline echocardiogram data were provided, with no knowledge of how left ventricular geometry changed after interventional and medicinal treatment.

The presence of concentric and ambiguous left ventricular hypertrophy was related with an elevated risk of non-fatal ischemic stroke in a large Chinese cohort with low cardiovascular risk.

Patients with dilated, concentric, and mixed left ventricular hypertrophy had a worse outcome than those without left ventricular hypertrophy.

Surprisingly, dilated and enlarged left ventricular hypertrophy was not linked to an increased risk of ischemic stroke.

These findings imply that using left ventricular chamber dilation to evaluate left ventricular hypertrophy is a relevant sub-phenotypes within the traditional two-group categorization.

A cardiologist is guiding a senior patient in hospital.
A cardiologist is guiding a senior patient in hospital.

Limitations Of Left Ventricular Hypertrophy Classification

Certain possible limitations must be recognized for the new 4-group left ventricular hypertrophy classification to be used correctly in clinical practice.

The 4-group left ventricular hypertrophy categorization method must be precise and based on numerical criteria to be valid.

According to some writers, this binary concept of left ventricular hypertrophy should be reinterpreted as a continuum from normal to remodeling, with potential implications for reverse remodeling.

Some studies grouped individuals with dilated and eccentric left ventricular hypertrophy together (dilated left ventricular hypertrophy). Nonetheless, these two groups are likely to have a distinct risk of having incident heart failure.

The only approach that correctly assesses left ventricular mass is a three-dimensional echocardiogram (3D), which does not make geometric assumptions about left ventricular geometry and wall thickening distribution.

Furthermore, a patient may only shift between categories if the reliability of echocardiographic measures is limited.

At the same time, it might represent a dynamic temporal transitional pattern. Previous findings revealed that changes in left ventricular shape over time might influence prognosis, comparable to many studies demonstrating improved prediction with left ventricular hypertrophy regression.

As a result, more than one examination of the left ventricular hypertrophy pattern may be required to further categorize individuals with left ventricular hypertrophy.

A high 3D-left ventricular mass/end-diastolic volume ratio in hypertensive individuals was associated with a more significant concentric left ventricular hypertrophy than a 2D-derived relative wall thickness.

There has been no direct comparison of the two approaches' capacity to predict clinical events, left ventricular hypertrophy classification agreement, or cardiovascular risk reclassification.

Left Ventricular Hypertrophy Future Prospects

The discovery of a broad range of alterations in end-diastolic volume, mass, and function in individuals with chronic heart failure is a fundamental finding of the enhanced left ventricular hypertrophy phenotypic characterization.

Left ventricular hypertrophy was affected by several parameters, including but not limited to gender, diabetes, prior myocardial infarction, obesity, and valve disorders.

There are possible underlying genetic elements that are yet unknown. Left ventricular hypertrophy categorization might be improved to differentiate the separate development of left ventricular geometric alterations from baseline.

Improved left ventricular hypertrophy characterization will also allow left ventricular geometry-directed therapy intervention to prevent the incidence of heart failure.

Recent studies revealed that, compared to patients with eccentric left ventricular hypertrophy, individuals with concentric left ventricular hypertrophy did not gain as much by up-titration angiotensin-converting enzyme inhibitors/angiotensin receptors blockers and beta-blockers in patients with heart failure with reduced ejection fraction.

People Also Ask

Is Left Ventricular Hypertrophy Heart Failure?

Aside from age, the most powerful predictor of unfavorable cardiovascular outcomes in the hypertensive population is left ventricular hypertrophy, an independent risk factor for coronary heart disease, sudden death, heart failure, and stroke.

How Long Can You Live With Left Ventricular Hypertrophy?

The risk of unexpected mortality in individuals with moderate hypertrophy (maximal wall thickness, 19 mm) was close to zero 10 years after the first examination and less than 3% after 20 years.

How Do You Treat Left Ventricular Hypertrophy?

Medication, a nonsurgical technique, surgery, implanted devices, and lifestyle modifications may be used to treat left ventricular enlargement caused by hypertrophic cardiomyopathy.

Amyloidosis. Medication, chemotherapy, and maybe a stem cell transplant treat amyloidosis.

How Serious Is Left Ventricular Hypertrophy?

Left ventricular hypertrophy (and similar underlying heart diseases) raises the risk of significant heart disease or death if left untreated.

Slowing or stopping the course of left ventricular hypertrophy reduces the risk of significant cardiac injury.

Conclusion

Chronic heart failure is a dynamic clinical illness with wide phenotypic diversity, making a "one-size-fits-all" strategy for management ineffective.

Many patients in clinical practice exhibit a mix of chronic pressure and volume overload, resulting in unique and more complicated left ventricular hypertrophy geometric patterns than previously thought, emphasizing the need for a better left ventricular hypertrophy categorization.

With this in mind, standard 2-group patterns are insufficient for risk stratifying left ventricular hypertrophy patients.

Preliminary data, on the other hand, supported the use of echocardiography for left ventricular remodeling evaluation based on end-diastolic volume, mass, and relative wall thickness.

It is time for doctors to examine new left ventricular hypertrophy categorization recommendations that will consider numerous characteristics of left ventricular shape and function, including underlying remodeling problems that may be acquired with current echocardiographic technologies.

However, further research is required to understand how it may be used in clinical decision-making.

About The Authors

Suleman Shah

Suleman Shah - Suleman Shah is a researcher and freelance writer. As a researcher, he has worked with MNS University of Agriculture, Multan (Pakistan) and Texas A & M University (USA). He regularly writes science articles and blogs for science news website immersse.com and open access publishers OA Publishing London and Scientific Times. He loves to keep himself updated on scientific developments and convert these developments into everyday language to update the readers about the developments in the scientific era. His primary research focus is Plant sciences, and he contributed to this field by publishing his research in scientific journals and presenting his work at many Conferences. Shah graduated from the University of Agriculture Faisalabad (Pakistan) and started his professional carrier with Jaffer Agro Services and later with the Agriculture Department of the Government of Pakistan. His research interest compelled and attracted him to proceed with his carrier in Plant sciences research. So, he started his Ph.D. in Soil Science at MNS University of Agriculture Multan (Pakistan). Later, he started working as a visiting scholar with Texas A&M University (USA). Shah’s experience with big Open Excess publishers like Springers, Frontiers, MDPI, etc., testified to his belief in Open Access as a barrier-removing mechanism between researchers and the readers of their research. Shah believes that Open Access is revolutionizing the publication process and benefitting research in all fields.

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