What do mild concentric left ventricular hypertrophy, a left ventricular ejection fraction of 55‑60 % on two‑dimensional echocardiography, and the recommendation for formal New York Heart Association heart‑failure staging indicate?

Understanding Your Echocardiogram Results

Your heart shows mild thickening of the left ventricle walls with preserved pumping function (55-60%), but these findings warrant formal heart failure staging to determine if you have early heart disease and guide appropriate management.

What Each Finding Means

Mild Concentric Left Ventricular Hypertrophy

• Concentric hypertrophy means the walls of your heart's main pumping chamber (left ventricle) have thickened uniformly while the cavity size remains normal 1
• This pattern is most commonly caused by chronic high blood pressure (hypertension), where your heart muscle adapts to pumping against increased resistance 1
• The thickening affects both diastolic function (how your heart relaxes and fills) and can alter longitudinal and radial heart muscle function 1
• "Mild" indicates the degree of thickening is in the early stages, but it still represents an abnormal cardiac adaptation 1

Left Ventricular Ejection Fraction of 55-60%

• Ejection fraction (EF) measures what percentage of blood your heart pumps out with each beat 2
• Your EF of 55-60% falls within the normal range (typically ≥50-55%) 1
• This means your heart's squeezing function is preserved, which is reassuring 2
• However, normal EF does not exclude heart failure—you can have heart failure with preserved ejection fraction (HFpEF), particularly when left ventricular hypertrophy is present 1, 3

Why NYHA Staging Is Recommended

The recommendation for formal NYHA (New York Heart Association) staging exists because:

• Left ventricular hypertrophy is the most potent predictor of adverse cardiovascular outcomes in hypertensive patients, independent of age, and increases risk for coronary disease, sudden death, heart failure, and stroke 3
• NYHA classification determines your functional capacity by assessing symptoms like dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and fatigue that limits exercise tolerance 2
• NYHA staging directly impacts treatment decisions, including eligibility for specific medications, devices, and interventions 1
• Even patients classified as NYHA Class I (no symptoms) with structural heart disease require monitoring, as approximately 28% experience adverse events over 5 years 4

What NYHA Staging Involves

Your physician will classify you into one of four functional classes based on symptom severity 2:

• Class I: No limitation of physical activity; ordinary activity does not cause symptoms 4
• Class II: Slight limitation; comfortable at rest but ordinary activity causes symptoms (often subclassified as IIA for dyspnea after running/climbing ≥2 flights, or IIB for dyspnea after fast walking/climbing 2 flights) 5
• Class III: Marked limitation; comfortable at rest but less-than-ordinary activity causes symptoms 1
• Class IV: Unable to carry out any physical activity without symptoms, or symptoms at rest 1

Clinical Implications and Next Steps

Your physician needs to determine:

• Whether you have any symptoms of heart failure (shortness of breath with activity, fatigue, leg swelling, difficulty lying flat) 2
• The underlying cause of your left ventricular hypertrophy (most commonly hypertension, but also aortic stenosis or hypertrophic cardiomyopathy) 1
• Your risk factors including coronary artery disease, diabetes, prior heart attack, and family history of heart disease 2
• Whether additional testing is needed, such as natriuretic peptides (BNP or NT-proBNP), stress testing, or coronary evaluation 2, 6

Treatment priorities will focus on:

• Aggressive blood pressure control to prevent progression of hypertrophy and reduce heart failure risk 3
• Regression of left ventricular hypertrophy, which significantly reduces adverse clinical outcomes 3
• Monitoring for development of diastolic dysfunction, which is directly related to the degree of myocardial fibrosis and represents the hemodynamic hallmark of hypertensive heart disease 3
• Assessment of left atrial size, as enlargement indicates chronically elevated filling pressures even when current symptoms are absent 1

Critical caveat: If you develop an ejection fraction <50% in the future, this represents a significant change requiring immediate reassessment of all heart failure medications and consideration for advanced therapies 1, 7