From the Guidelines
Borderline Left Ventricular Hypertrophy (LVH) on an echocardiogram is a significant finding that requires clinical correlation and possibly follow-up monitoring, as it may indicate an increased risk of cardiovascular disease, particularly if the maximal LV wall thickness is between 13-14 mm, as stated in the 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy 1.
Clinical Significance
The clinical significance of borderline LVH lies in its potential progression to more severe forms of LVH, which can lead to diastolic dysfunction, heart failure, arrhythmias, and increased cardiovascular risk. According to the guideline, a maximal LV wall thickness of 13-14 mm is considered borderline, particularly in the presence of other compelling information, such as family history of HCM 1.
Differential Diagnosis
The differential diagnosis of borderline LVH includes hypertensive heart disease, athlete's heart, and other conditions that can cause LV hypertrophy, such as aortic stenosis or hypertrophic cardiomyopathy. The guideline emphasizes the importance of distinguishing between pathologic LV hypertrophy (i.e., HCM) and physiologic LV hypertrophy (i.e., athlete's heart) 1.
Management
If borderline LVH is detected, lifestyle modifications, such as reducing sodium intake, regular exercise, weight management, and blood pressure control, may be recommended. Hypertension is the most common cause of LVH, so blood pressure medications may be prescribed if elevated. Regular follow-up echocardiograms every 1-2 years are typically recommended to monitor for progression.
Key Considerations
Key considerations in the management of borderline LVH include:
- Clinical correlation and possibly follow-up monitoring
- Distinguishing between pathologic and physiologic LV hypertrophy
- Lifestyle modifications and blood pressure control
- Regular follow-up echocardiograms to monitor for progression As stated in the guideline, any degree of wall thickness is compatible with the presence of the HCM genetic substrate, and an emerging subgroup within the broad clinical spectrum is composed of family members with disease-causing sarcomere mutations but without evidence of the disease phenotype (i.e., LV hypertrophy) 1.
From the Research
Significance of Borderline Left Ventricular Hypertrophy (LVH)
- Borderline Left Ventricular Hypertrophy (LVH) is a condition where the left ventricle of the heart is thicker than normal, which can be detected by echocardiography 2.
- The presence of LVH is a powerful, independent risk factor for all cardiovascular diseases, including coronary heart disease, stroke, and cardiac failure 3, 4, 5.
- The significance of borderline LVH is not yet well defined, but it is believed to be a marker of increased cardiovascular risk 2.
- LVH can be caused by various factors, including hypertension, obesity, and glucose intolerance, and can be reversed with optimal antihypertensive therapy 3, 4, 6.
Risk Factors Associated with LVH
- Hypertension is a major influence on the development of LVH, and the prognostic power of LVH is likely multifactorial 5.
- Other risk factors associated with LVH include age, male sex, and advancing age 3, 6.
- The presence of LVH is also associated with an increased risk of sudden cardiac death, ventricular ectopy, and cardiovascular events 3.
Diagnosis and Treatment of LVH
- LVH can be detected non-invasively using electrocardiography or echocardiography 4.
- Optimal blood pressure control is the primary intervention for subjects with hypertension and LVH, and several antihypertensive treatments can reverse LVH and improve cardiovascular outcomes 4, 5, 6.
- Angiotensin II receptor blockers and ACE inhibitors have been shown to reverse LVH and improve cardiovascular outcomes independent of blood pressure reduction 5, 6.