From the Guidelines
Moderate left ventricular hypertrophy (LVH) is defined as a wall thickness of 1.4-1.6 cm in men or 1.3-1.5 cm in women, or a left ventricular mass (g/m2) of 117-130 in men or 103-116 in women, while severe LVH is defined as a wall thickness greater than 1.7 cm in men or greater than 1.6 cm in women, or a left ventricular mass (g/m2) greater than 131 in men or greater than 113 in women, according to the European Heart Journal study 1.
Definition of Left Ventricular Hypertrophy
The definition of left ventricular hypertrophy is based on the measurement of the left ventricular wall thickness and left ventricular mass.
- The left ventricular wall thickness is measured in centimeters (cm) and is used to define the severity of LVH.
- The left ventricular mass is measured in grams per square meter (g/m2) and provides a more precise assessment of LVH.
Echo Criteria for Moderate or Severe LVH
The echo criteria for moderate or severe LVH are as follows:
- Moderate LVH: wall thickness of 1.4-1.6 cm in men or 1.3-1.5 cm in women, or left ventricular mass (g/m2) of 117-130 in men or 103-116 in women.
- Severe LVH: wall thickness greater than 1.7 cm in men or greater than 1.6 cm in women, or left ventricular mass (g/m2) greater than 131 in men or greater than 113 in women, as stated in the study 1.
Clinical Significance of LVH
The clinical significance of identifying moderate to severe LVH is substantial, as it independently predicts adverse cardiovascular outcomes, including heart failure, arrhythmias, and sudden cardiac death, making it an important finding that often necessitates aggressive management of the underlying cause, as noted in the study 1.
From the Research
Echo Criteria for Moderate or Severe LVH
The echo criteria for detecting left ventricular hypertrophy (LVH) include various measurements such as left ventricular mass (LVM), LVM index (LVMI), cross-sectional area (CSA), septal and posterior wall thickness (IVST and PWT), LV internal dimension (LVID), and relative wall thickness (RWT) 2.
- The study found that echo criteria based on LVM are more sensitive than other measurements for detection of necropsy-proven pressure-overload LVH 2.
- The prevalence of LVH in hypertension is highly dependent on the population studied, with different populations showing varying degrees of LVH detection using different echo criteria 2.
- Another study compared the effects of angiotensin receptor antagonist, angiotensin converting enzyme inhibitor, and their combination on regression of left ventricular hypertrophy in diabetic patients on recent onset hemodialysis therapy, but did not provide specific echo criteria for moderate or severe LVH 3.
- Other studies discussed the effects of beta-blockers and angiotensin-converting enzyme inhibitors on left ventricular hypertrophy regression in hypertensive patients, but also did not provide specific echo criteria for moderate or severe LVH 4, 5, 6.
Detection of LVH
- The detection of LVH using echocardiography is dependent on the criteria used, with different criteria showing varying degrees of sensitivity and specificity 2.
- The use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers has been shown to provide beneficial effects on LVH regression and on cardiac remodeling in the presence of hypertension and heart failure 4, 3, 6.
Limitations
- The available studies do not provide a clear definition of the echo criteria for moderate or severe LVH.
- Further research is needed to establish specific echo criteria for detecting moderate or severe LVH.