Abstract
Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.
Highlights
Nowadays, the perpetual controversy between the importance of structural and functional anomalies in the failed heart appears to lack consensus [1]
Left Ventricular Mass and Volume Quantification defined by increased ventricular mass according to the classification and partition values proposed by the American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) [2], is a strong independent predictor of cardiovascular risk in adults undergoing assessment for any indication [3]
The most commonly used categorization for left ventricular hypertrophy (LVH) remodeling patterns is proposed by the ASE/EACVI, which uses only left ventricular (LV) mass and relative wall thickness (RWT) as classifying variables with two known basic patterns: concentric and eccentric LVH [2]
Summary
The perpetual controversy between the importance of structural and functional anomalies in the failed heart appears to lack consensus [1]. To resolve the dynamic relationship between LV dilation and myocardial thickening in LVH pathophysiology, several echocardiographic studies have linked the 4-group classification system to clinical outcome in hypertensive patients [13, 14], patients with coronary artery disease [17], patients with asymptomatic (stage A and B) heart failure [18], in the general population with normal LV systolic function and no history of heart failure [25], and patients with valvular heart disease [16, 26]. The Losartan Intervention for Endpoint Reduction Echocardiography sub-study was the first to use readily available echocardiographic measurements to reproduce the results of CMR [9] in 939 hypertensive patients who were treated for 4.8 years They found that of all-cause mortality risk was increased for patients with dilated, concentric, and mixed LVH [HR (95%CI)]: 7.3 (2.8–19), 2.4 (1.4–4.0), 2.4 (1.4–4.0), respectively. The same result was found for cardiovascular mortality and the composite endpoint of myocardial infarction,
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