Is mild concentric left ventricular hypertrophy the same as increased wall thickness?

Mild Concentric Left Ventricular Hypertrophy vs. Wall Thickness

No, mild concentric left ventricular hypertrophy is not the same as simply having increased wall thickness—concentric LVH is a specific geometric pattern characterized by increased wall thickness with a normal or small LV cavity size and increased relative wall thickness, whereas isolated wall thickening can occur in multiple geometric patterns including eccentric hypertrophy. 1

Understanding Concentric LVH as a Distinct Pattern

Concentric LVH represents a specific adaptive response to chronic pressure overload (such as hypertension or aortic stenosis) where the ventricle responds by thickening its walls symmetrically while maintaining or reducing cavity size. 1 This differs fundamentally from other patterns where wall thickness may increase:

• Concentric LVH: Increased wall thickness + normal/small LV cavity + increased LV mass + increased relative wall thickness (RWT >0.42) 1
• Eccentric LVH: Increased wall thickness + enlarged LV cavity + increased LV mass + normal RWT 1
• Concentric remodeling: Normal wall thickness + normal/small cavity + normal LV mass + increased RWT 1

Key Distinguishing Features

The critical distinction lies in the geometric relationship between wall thickness and cavity size. 1 Concentric LVH specifically indicates:

• Pressure overload adaptation: Response to high systemic pressure with high peripheral resistance 1
• Symmetric thickening: Both interventricular septum and posterior wall increase proportionally 1
• Preserved or reduced cavity dimensions: Unlike eccentric patterns where cavity enlarges 1

In contrast, eccentric hypertrophy shows increased wall thickness but is associated with volume overload (valvular regurgitation, high cardiac output states), normal systemic pressure, enlarged LV cavity, and often low-normal or mildly impaired systolic function. 1

Clinical Implications of the Distinction

The geometric pattern matters prognostically and therapeutically. Patients with concentric LVH demonstrate:

• More abnormal arterial structure and function compared to eccentric hypertrophy, including increased arterial wall thickness, cross-sectional area, and elastic modulus 2
• Different diastolic dysfunction patterns and longitudinal/radial myocardial function changes 1
• Higher cardiovascular risk compared to other geometric patterns, even when blood pressure and LV mass are similar 2

Measurement Considerations

Wall thickness alone is insufficient for classification—you must also assess:

• LV cavity dimensions (end-diastolic diameter/volume) 1
• LV mass (calculated from wall thickness and cavity size) 1
• Relative wall thickness (2 × posterior wall thickness / LV end-diastolic diameter) 1

Common pitfall: Assuming any increased wall thickness equals concentric LVH. 1 You must exclude other causes of wall thickening including hypertrophic cardiomyopathy (where wall thickness ≥15 mm with specific patterns, often asymmetric), 1, 3 athlete's heart (physiologic adaptation with cavity enlargement), 1 and infiltrative diseases (amyloidosis, Fabry disease). 4

Practical Assessment Algorithm

When encountering increased wall thickness:

1. Measure LV cavity size and calculate LV mass 1
2. Calculate relative wall thickness to determine geometry 1
3. Assess for secondary causes: hypertension, valvular disease, athletic training 1
4. Evaluate distribution: symmetric (concentric) vs. asymmetric (consider HCM) 1
5. Consider imaging discrepancies: MRI and echocardiography can differ by median 3 mm in wall thickness measurements 5

Critical caveat: In hypertrophic cardiomyopathy, approximately one-third of patients have segmental wall thickening involving only a small portion of the left ventricle with normal calculated LV mass, 1 which would not be classified as concentric LVH despite increased regional wall thickness.