Left Ventricular Hypertrophy

Left ventricular hypertrophy (LVH) is an increase in the mass of the muscular wall of the heart's left ventricle, the chamber that pumps blood into the systemic circulation. It generally develops through enlargement of individual cardiac muscle cells, or cardiomyocytes. LVH is a structural finding rather than a single disease and can result from several physiological or pathological processes .¹

A common cause of pathological LVH is prolonged pressure overload, particularly from high blood pressure or aortic valve stenosis. The ventricle adapts to increased workload by increasing muscle mass. LVH can also occur with other forms of cardiac loading, infiltrative or storage disorders, and genetic heart diseases. Exercise training can produce a physiological increase in left ventricular mass as part of the athlete's heart .¹

The geometry of left ventricular hypertrophy can vary. In concentric hypertrophy, ventricular wall thickness increases relative to chamber size, a pattern commonly associated with pressure overload. In eccentric hypertrophy, increased ventricular mass occurs with a relatively larger cavity. Echocardiography and cardiac magnetic resonance imaging can assess left ventricular mass, wall thickness, chamber dimensions, and the distribution of hypertrophy .¹

LVH is not synonymous with hypertrophic cardiomyopathy (HCM). HCM is a specific cardiomyopathy characterized by increased left ventricular wall thickness that is not adequately explained by another cardiac, systemic, or metabolic condition. Hypertension, athletic training, valve disease, and HCM can therefore all produce increased ventricular thickness or mass, but they represent different underlying processes .^1,2