From the Guidelines
Left ventricular hypertrophy (LVH) is a distinct cardiac condition that should be differentiated from hypertrophic obstructive cardiomyopathy (HOCM) based on its adaptive thickening of the left ventricular wall in response to chronic pressure overload, whereas HOCM is a genetic disorder with asymmetric septal hypertrophy and dynamic left ventricular outflow tract obstruction. LVH is typically caused by conditions like hypertension or aortic stenosis, representing a compensatory mechanism that eventually becomes maladaptive 1. In contrast, HOCM is caused by mutations in genes encoding sarcomeric proteins and often presents with symptoms like exertional dyspnea, chest pain, syncope, and has a risk of sudden cardiac death, especially in young athletes 1.
Key Differences
- The pattern of hypertrophy: concentric in LVH versus asymmetric in HOCM
- Causation: acquired versus genetic
- Clinical manifestations: LVH treatment focuses on controlling the underlying cause, while HOCM management includes beta-blockers, calcium channel blockers, surgical myectomy, or alcohol septal ablation for symptomatic patients with obstruction 1
- Echocardiography is crucial for differentiating these conditions, showing the pattern of hypertrophy and assessing for dynamic obstruction in HOCM 1
Diagnosis and Management
- LVH diagnosis is based on a normative basis, with separate cutoffs required for men and women, and correction for body surface area (BSA) to account for obesity-related left ventricular mass (LVM) 1
- LA enlargement is related to LVM, overweight, higher fasting glucose, and metabolic syndrome in hypertensive patients 1
- Echocardiography is essential for differentiating LVH from HOCM, and management should be tailored to the underlying condition, with a focus on controlling hypertension in LVH and addressing dynamic obstruction in HOCM.
From the Research
Left Ventricular Hypertrophy
- Left ventricular hypertrophy (LVH) is a condition where the muscle mass of the left ventricle increases, which can lead to cardiovascular morbidity and mortality 2.
- The risk of acute myocardial infarction, congestive heart failure, sudden death, and other cardiovascular events increases six- to eightfold with the presence of LVH 2.
- LVH can be caused by various factors, including hypertension, obesity, advanced age, valvular heart disease, and other disorders that increase the hemodynamic burden 2, 3, 4.
Comparison with Hocum
- There is no information available on "hocum" in the provided studies, suggesting that it may not be a relevant or recognized medical term in the context of left ventricular hypertrophy.
Treatment and Management
- Controlling arterial pressure, sodium restriction, and weight loss can facilitate the regression of LVH 3.
- Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, followed by calcium channel antagonists, can rapidly facilitate the regression of LVH 3.
- Lifestyle changes, medications, surgery, and implantable devices can be used to manage LVH, depending on the underlying cause 5.
- ACE inhibitors, such as captopril, have been shown to reduce left ventricular mass and improve coronary flow reserve in patients with hypertensive left ventricular hypertrophy 6.