From the Guidelines
Borderline concentric left ventricular hypertrophy, mild systolic anterior motion, and trace mitral regurgitation are most likely caused by chronic hypertension, hypertrophic cardiomyopathy, or athletic heart syndrome, rather than directly by anxiety and stress. The possible causes of these conditions are numerous and can be attributed to various systemic disorders, including metabolic and multiorgan syndromes, as well as secondary causes of left ventricular hypertrophy (LVH) such as remodeling secondary to athletic training or long-standing systemic hypertension 1. Some key points to consider include:
- The magnitude and distribution of increased left ventricular wall thickness can be similar to that of isolated hypertrophic cardiomyopathy (HCM) caused by variants in sarcomeric genes, but the pathophysiologic mechanisms responsible for hypertrophy, natural history, and treatment strategies are not the same 1.
- Other cardiac or systemic diseases capable of producing LVH should not be labeled as HCM and can include conditions such as hemodynamic obstruction caused by left-sided obstructive lesions or obstruction after antero-apical infarction and stress cardiomyopathy 1.
- Anxiety and stress can contribute to hypertension, which over time could lead to LVH, but they typically do not directly cause structural heart abnormalities like LVH or systolic anterior motion (SAM) 1.
- A number of clinical markers and testing strategies can be used to help differentiate between HCM and conditions of physiologic LVH, including the pattern and distribution of LV wall thickening, as well as the presence of other morphologic abnormalities such as hypertrophied and apically displaced papillary muscles or myocardial crypts 1. It is essential to conduct further clinical evaluation to determine the specific underlying cause and appropriate management of these conditions.
From the Research
Possible Causes of Borderline Concentric Left Ventricular (LV) Hypertrophy
- Borderline concentric LV hypertrophy can be caused by hypertension, as it is a maladaptive response to chronic pressure overload 2
- Other possible causes include mitral annulus calcification, which can lead to systolic anterior motion of the anterior leaflet of the mitral valve and left ventricular outflow tract obstruction 3
- Mild hypertensive heart disease can also cause borderline concentric LV hypertrophy, systolic anterior motion, and left ventricular outflow tract obstruction 4
Relationship between Anxiety, Stress, and Borderline Concentric LV Hypertrophy
- There is no direct evidence in the provided studies to suggest that anxiety and stress can cause borderline concentric LV hypertrophy, mild systolic anterior motion, and trace mitral regurgitation
- However, it is known that hypertension is a major risk factor for left ventricular hypertrophy, and anxiety and stress can contribute to hypertension
Risk Factors for Progression to Systolic Dysfunction
- Interval myocardial infarction, QRS prolongation, and elevated follow-up arterial impedance are risk factors for developing left ventricular systolic dysfunction in patients with concentric LV hypertrophy and a normal ejection fraction 5
- Hypertension, left ventricular hypertrophy, and sudden cardiac death are also related, with left ventricular hypertrophy being a powerful, independent predictor of atrial fibrillation, ventricular arrhythmias, and sudden cardiac death 6
Treatment and Management
- Controlling arterial pressure, sodium restriction, and weight loss can facilitate the regression of left ventricular hypertrophy 2
- Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, followed by calcium channel antagonists, can also facilitate the regression of left ventricular hypertrophy 2
- Angiotensin II antagonists may be considered as the treatment of choice for patients with mild hypertensive heart disease and left ventricular outflow tract obstruction 4