From the Guidelines
Concentric left ventricular hypertrophy (LVH) is primarily caused by pressure overload on the heart, most commonly from hypertension, as evidenced by the 2015 European Heart Journal study 1. When blood pressure remains elevated over time, the left ventricle must work harder to pump blood against increased resistance in the arteries. This causes the heart muscle walls to thicken (hypertrophy) while maintaining a normal-sized chamber, resulting in concentric LVH. Some key points to consider about concentric LVH include:
- It is characterized by normal cavity size, uniformly increased LV wall thickness, and increased left ventricular mass (LVM) 1.
- The condition is an adaptive response to high systemic pressure caused by hypertension or diseases such as aortic stenosis, coupled with high peripheral resistance 1.
- Concentric LVH and changes in LV geometry have been shown to affect both men and women regardless of age, and are also associated with changes in diastolic function, longitudinal and radial myocardial function, and atrial size 1. Other causes of concentric LVH may include aortic stenosis, where narrowing of the aortic valve creates pressure overload. The thickening occurs as a compensatory mechanism to normalize wall stress according to Laplace's law, but eventually becomes maladaptive, leading to decreased cardiac compliance, diastolic dysfunction, and potentially heart failure. Treatment focuses on controlling the underlying cause, particularly aggressive blood pressure management with medications, which can help reverse the hypertrophy over time.
From the Research
Causes of Concentric Left Ventricular Hypertrophy (LVH)
- Concentric LVH can be caused by diverse conditions including:
- It is a maladaptive response to chronic pressure overload 4
- Controlling arterial pressure, sodium restriction, and weight loss can facilitate the regression of LVH 4
- Choice of antihypertensive agents may be important when treating a patient with hypertensive LVH, with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers followed by calcium channel antagonists being effective in facilitating the regression of LVH 4
Risk Factors and Consequences
- LVH is an independent risk factor and predictor of cardiovascular events and all-cause mortality 2
- Patients with LVH are at increased risk for stroke, congestive heart failure, coronary heart disease, and sudden cardiac death 2
- LVH represents both a manifestation of the effects of hypertension and other CV risk factors over time as well as an intrinsic condition causing pathologic changes in the CV structure and function 2
- Blood pressure control with lifestyle changes and antihypertensive agents has been demonstrated to prevent and regress LVH 5