What is the significance of asymmetric basal septal left ventricular hypertrophy (LVH)?

From the Guidelines

Asymmetric basal septal left ventricular hypertrophy (LVH) is most commonly associated with hypertrophic cardiomyopathy (HCM), a genetic heart disorder, and should be managed with beta-blockers or calcium channel blockers to reduce symptoms and prevent complications, as recommended by the 2020 AHA/ACC guideline 1. The condition is characterized by abnormal thickening of the basal portion of the interventricular septum, which can obstruct blood flow from the left ventricle, impair diastolic filling, and create areas of disorganized cardiac muscle that may trigger dangerous arrhythmias. Key aspects of management include:

• Medications: beta-blockers such as metoprolol (25-100 mg twice daily) or calcium channel blockers like verapamil (120-360 mg daily in divided doses) to reduce heart rate, improve diastolic filling, and decrease outflow obstruction 1.
• Lifestyle modifications: patients should avoid dehydration and excessive alcohol consumption, which can worsen symptoms.
• Regular monitoring: cardiac monitoring with echocardiography every 1-2 years is recommended to track disease progression 1.
• Additional treatments: for patients with significant outflow tract obstruction, disopyramide (100-300 mg twice daily) may be added, and in severe cases refractory to medication, surgical myectomy or alcohol septal ablation might be considered 1. It is essential to differentiate HCM from other conditions that can produce LVH, such as systemic disorders or secondary causes of LV hypertrophy, as the pathophysiologic mechanisms and treatment strategies may differ 1. Genetic counseling is also crucial, given the 50% inheritance risk of HCM 1.

From the Research

Asymmetric Basal Septal LVH

• Asymmetric basal septal left ventricular hypertrophy (LVH) is a condition where the septal wall of the left ventricle is thicker than normal, which can be associated with hypertension and other cardiovascular diseases.
• The provided studies do not directly address asymmetric basal septal LVH, but they discuss the effects of beta blockers on left ventricular hypertrophy in general.
• According to 2, beta blockers can induce regression of LVH in hypertensive subjects, but the question of whether reversal of LVH represents a beneficial or harmful byproduct of antihypertensive treatment with beta blockers is still unanswered.
• A study published in 3 suggests that certain beta blockers, such as bisoprolol, may be reevaluated in guidelines for hypertension treatment in patients with left ventricular hypertrophy to diminish the ventricular arrhythmic risk.
• Another study 4 found that angiotensin-converting enzyme inhibitors may provide the most pronounced reduction in left ventricular mass per millimeter of mercury of blood pressure reduction, and that angiotensin receptor blockers (ARBs) may also be effective in regressing LVH.
• A more recent study 5 found that metoprolol improves left ventricular longitudinal strain at rest and during exercise in obstructive hypertrophic cardiomyopathy, which may be relevant to the treatment of asymmetric basal septal LVH.
• A review article 6 discusses the role of beta blockers in LVH regression, noting that while they may have a minor role, ACE-inhibitors and angiotensin receptor blockers are more potent in regressing LVH.

Treatment Options

• The treatment options for asymmetric basal septal LVH are not directly addressed in the provided studies, but the studies suggest that beta blockers, ACE-inhibitors, and angiotensin receptor blockers may be effective in regressing LVH.
• The choice of treatment may depend on the underlying cause of the LVH and the presence of other cardiovascular diseases.
• Further research is needed to determine the most effective treatment options for asymmetric basal septal LVH.

Key Findings

• Beta blockers can induce regression of LVH in hypertensive subjects 2.
• Certain beta blockers, such as bisoprolol, may be reevaluated in guidelines for hypertension treatment in patients with left ventricular hypertrophy to diminish the ventricular arrhythmic risk 3.
• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be effective in regressing LVH 4.
• Metoprolol improves left ventricular longitudinal strain at rest and during exercise in obstructive hypertrophic cardiomyopathy 5.
• Beta blockers may have a minor role in LVH regression, while ACE-inhibitors and angiotensin receptor blockers are more potent 6.