From the Guidelines
The main difference between eccentric and concentric ventricular hypertrophy lies in their structural changes and causes, with concentric hypertrophy involving thickening of the ventricular wall with a normal or reduced chamber size, and eccentric hypertrophy featuring both wall thickening and chamber enlargement. The heart's adaptation to specific hemodynamic challenges is reflected in these different patterns, with concentric hypertrophy developing to generate higher pressures against resistance, and eccentric hypertrophy accommodating increased blood volume 1. Key characteristics of concentric hypertrophy include a normal cavity size, uniformly increased left ventricular (LV) wall thickness, and increased left ventricular mass (LVM), often associated with hypertension or aortic stenosis 1. In contrast, eccentric hypertrophy is associated with volume overload conditions, such as valve regurgitation or heart failure, and is characterized by increased LV cavity size, normal LV wall thickness, and increased LVM 1. Both types of hypertrophy represent compensatory mechanisms that can eventually become maladaptive if the underlying condition persists, potentially leading to heart failure through different pathways. Some of the key features that distinguish between these two types of hypertrophy include:
- LV geometry, with concentric hypertrophy showing a normal or reduced chamber size and eccentric hypertrophy showing chamber enlargement
- Wall thickness, with concentric hypertrophy having uniformly increased LV wall thickness and eccentric hypertrophy having normal LV wall thickness
- LVM, with both types showing increased LVM but differing in the underlying causes and hemodynamic challenges
- Associated conditions, such as hypertension, aortic stenosis, valve regurgitation, and heart failure, which can influence the development of concentric or eccentric hypertrophy 1. Understanding these differences is crucial for accurate diagnosis and management of patients with ventricular hypertrophy, as it can impact treatment strategies and outcomes.
From the Research
Definition and Characteristics
- Eccentric ventricular hypertrophy is characterized by an increase in the size of the ventricular chamber, resulting in a thinner ventricular wall [(2,3,4,5)].
- Concentric ventricular hypertrophy is marked by a thickening of the ventricular wall, without a significant increase in chamber size [(2,3,4,5)].
Clinical Implications
- Patients with eccentric ventricular hypertrophy tend to have a higher incidence of heart failure with reduced ejection fraction [(2,4)].
- Those with concentric ventricular hypertrophy are more likely to develop heart failure with preserved ejection fraction [(3,4)].
- The response to treatment may vary between the two types, with patients with eccentric hypertrophy potentially benefiting more from certain therapies 2.
Pathophysiology
- Eccentric hypertrophy is often associated with volume overload, leading to an increase in stroke volume 5.
- Concentric hypertrophy is typically seen in pressure overload, resulting in a normalization of wall stress 5.
- The development of hypertrophy involves an imbalance between myocardial protein synthesis and degradation, with different mechanisms at play in pressure and volume overload 5.
Biomarkers and Outcomes
- N-terminal pro-B-type natriuretic peptide is a key biomarker in eccentric hypertrophy, while tumour necrosis factor receptor 1 and other markers are more central in concentric hypertrophy 2.
- Patients with eccentric and concentric hypertrophy may have distinct clinical and biomarker profiles, influencing their outcomes and treatment responses [(2,3)].