Prognostic Significance of Left Ventricular Hypertrophy Regression

Abstract

In hypertension, left ventricular hypertrophy (LVH) is initially a useful compensatory process, that represents an adaptation to increased ventricular wall stress; however, it is also the first step toward the development of overt clinical disease, such as congestive heart failure, cardiac dysrrhythmias, and ischemic heart disease. In fact, the Framingham Study has shown that once LVH is recognized clinically it constitutes a powerful independent risk factor for future cardiovascular morbid events whether assessed by ECG or echocardiography, the latter being a specific, repeatable and far more sensitive measure of LVH^1,2. The echocardiographic technique has demonstrated that the geometric adaptation of the left ventricle to increased cardiac load may be different among patients. Concentric hypertrophy is characterized by increased mass and increased relative wall thickness, whereas eccentric hypertrophy is characterized by increased mass and relative wall thickness < 0.45; on the other hand, concentric remodeling occurs when there is increased thickness with respect to radius, without increased LV mass. Concentric hypertrophy appears to carry the highest risk and eccentric hypertrophy an intermediate risk, whereas concentric remodeling is probably associated with a smaller, albeit still consistent risk³.