No, Concentric LV Remodeling is NOT the Same as Hypertrophy
Concentric LV remodeling and concentric hypertrophy are distinct geometric patterns that differ fundamentally in left ventricular mass—remodeling has normal LV mass with increased wall thickness, while hypertrophy has increased LV mass with increased wall thickness. 1
Key Distinguishing Features
Concentric Remodeling
- Normal LV mass: ≤115 g/m² (men) or ≤95 g/m² (women) 1
- Increased relative wall thickness (RWT): ≥0.42 1
- Normal or small LV cavity size with disproportionate wall thickening relative to chamber dimensions 2
- Represents an earlier adaptive response to pressure overload where volume "underload" offsets the mass-increasing effects of pressure overload 3
Concentric Hypertrophy
- Increased LV mass: >115 g/m² (men) or >95 g/m² (women) 1
- Increased RWT: ≥0.42 1
- Develops from chronic pressure overload with sarcomeres added in parallel, causing increased wall thickness 4
- Represents true myocardial hypertrophy with increased total cardiac muscle mass 4
Clinical Significance: Why This Distinction Matters
Prognostic Implications
Both patterns carry adverse cardiovascular risk, but through different mechanisms:
- Concentric remodeling independently predicts increased cardiovascular morbidity (relative risk 2.56) even with normal LV mass 5
- This pattern shows more dramatic diastolic dysfunction degradation than other geometric patterns 2
- Patients with concentric remodeling demonstrate reduced systolic function with lower stroke volume (84 vs 111 mL), lower midwall fractional shortening (20% vs 22%), and 42% classified below the 5th percentile for myocardial function despite normal LV mass 6
Hemodynamic Differences
- Concentric remodeling: Highest peripheral resistance with low-normal cardiac index, reflecting pure pressure overload with volume underload 3
- Concentric hypertrophy: Combined pressure overload with true hypertrophic response 3
Common Clinical Pitfall
Do not assume normal LV mass means normal cardiac function. The European Association of Cardiovascular Imaging and American Society of Echocardiography mandate that echocardiography reports describe LV geometry using all four categories: normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy 1. Missing the diagnosis of concentric remodeling because LV mass is "normal" leads to undertreatment of a high-risk geometric pattern.
Treatment Approach
Despite having normal LV mass, concentric remodeling requires aggressive treatment identical to that for concentric hypertrophy:
- First-line: Angiotensin receptor blockers (ARBs), particularly losartan, or ACE inhibitors 2
- Combination therapy: Consider aldosterone antagonists (eplerenone) or calcium channel blockers (verapamil/diltiazem) for persistent diastolic dysfunction 2
- Target: Aggressive blood pressure control, as treatment-induced LV mass reduction (even from "normal" baseline) independently reduces cardiovascular events 2
The distinction between these patterns is not academic—concentric remodeling represents a maladaptive geometric response that predicts adverse outcomes despite normal LV mass 5, 6.