Left ventricular hypertrophy

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"LVH" redirects here. For other uses, see LVH (disambiguation).
Left ventricular hypertrophy
cardiovascular MRI[1]
Differential diagnosisAthletic heart syndrome

Left ventricular hypertrophy (LVH) is thickening of the heart muscle of the left ventricle of the heart, that is, left-sided ventricular hypertrophy and resulting increased left ventricular mass.

Causes

While ventricular hypertrophy

high blood pressure.[2] It is one aspect of ventricular remodeling
.

While LVH itself is not a disease, it is usually a marker for disease involving the heart.

muscle of the heart.[citation needed
] Causes of increased afterload that can cause LVH include
aortic insufficiency and hypertension. Primary disease of the muscle of the heart that cause LVH are known as hypertrophic cardiomyopathies, which can lead into heart failure.[citation needed
]

Long-standing

mitral insufficiency also leads to LVH as a compensatory mechanism.[citation needed
]

Associated genes include

OGN, osteoglycin.[4]

Diagnosis

The commonly used method to diagnose LVH is

electrocardiogram (ECG) often shows signs of increased voltage from the heart in individuals with LVH, so this is often used as a screening test to determine who should undergo further testing.[citation needed
]

Echocardiography

Left ventricular hypertrophy grading
by posterior wall thickness[5]
Mild 12 to 13 mm
Moderate >13 to 17 mm
Severe >17 mm

Two dimensional echocardiography can produce images of the left ventricle. The thickness of the left ventricle as visualized on echocardiography correlates with its actual mass. Left ventricular mass can be further estimated based on geometric assumptions of ventricular shape using the measured wall thickness and internal diameter.[6] Average thickness of the left ventricle, with numbers given as 95% prediction interval for the short axis images at the mid-cavity level are:[7]

  • Women: 4 – 8 mm
  • Men: 5 – 9 mm

CT & MRI

CT and MRI-based measurement can be used to measure the left ventricle in three dimensions and calculate left ventricular mass directly. MRI based measurement is considered the “gold standard” for left ventricular mass,[8] though is usually not readily available for common practice. In older individuals, age related remodeling of the left ventricle's geometry can lead to a discordancy between CT and echocardiographic based measurements of left ventricular mass.[9]

ECG criteria

Left ventricular hypertrophy with secondary repolarization abnormalities as seen on ECG
Histopathology of (a) normal myocardium and (b) myocardial hypertrophy. Scale bar indicates 50 μm.
Gross pathology of left ventricular hypertrophy. Left ventricle is at right in image, serially sectioned from apex to near base.

There are several sets of criteria used to diagnose LVH via electrocardiography.

specificity
are increased.

The Sokolow-Lyon index:[11][12]

  • S in V1 + R in V5 or V6 (whichever is larger) ≥ 35 mm (≥ 7 large squares)
  • R in aVL ≥ 11 mm

The Cornell voltage criteria[13] for the ECG diagnosis of LVH involve measurement of the sum of the R wave in lead aVL and the S wave in lead V3. The Cornell criteria for LVH are:

  • S in V3 + R in aVL > 28 mm (men)
  • S in V3 + R in aVL > 20 mm (women)

The Romhilt-Estes point score system ("diagnostic" >5 points; "probable" 4 points):

ECG Criteria Points
Voltage Criteria (any of):
  1. R or S in limb leads ≥20 mm
  2. S in V1 or V2 ≥30 mm
  3. R in V5 or V6 ≥30 mm
 3
ST-T Abnormalities:
  • ST-T vector opposite to QRS without digitalis
  • ST-T vector opposite to QRS with digitalis

3
1

Negative terminal P mode in V1 1 mm in depth and 0.04 sec in duration (indicates left atrial enlargement) 3
Left axis deviation (QRS of −30° or more) 2
QRS duration ≥0.09 sec 1
Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec) 1

Other voltage-based criteria for LVH include:

  • Lead I: R wave > 14 mm
  • Lead aVR: S wave > 15 mm
  • Lead aVL: R wave > 12 mm
  • Lead aVF: R wave > 21 mm
  • Lead V5: R wave > 26 mm
  • Lead V6: R wave > 20 mm

Diagnostic accuracy of electrocardiography in left ventricular hypertrophy can be enhanced with artificial intelligence analysis.[14]

Treatment

Treatment is typically focused on resolving the cause of the LVH with the enlargement not permanent in all cases. In some cases the growth can regress with the reduction of blood pressure.[15]

LVH may be a factor in determining treatment or diagnosis for other conditions, for example, LVH is used in the staging and risk stratification of Non-ischemic cardiomyopathies such as Fabry's Disease.[16] Patients with LVH may have to participate in more complicated and precise diagnostic procedures, such as Echocardiography or Cardiac MRI.[17][18]

See also

References

  1. ^
    S2CID 38333896
    .
  2. ^ "Ask the doctor: Left Ventricular Hypertrophy". Retrieved 2007-12-07.
  3. PMID 18030317
    .
  4. PMID 18443592
    .
  5. S2CID 29478910
    .
  6. PMID 25559473
    .
  7. PMID 22705587
    .
  8. S2CID 16598370
    .
  9. PMID 31648248
    .
  10. ^ "Lesson VIII - Ventricular Hypertrophy". Retrieved 2009-01-07.
  11. PMID 18107386
    .
  12. S2CID 2662286
    .
  13. S2CID 25815927
    .
  14. PMID 37103054
    .
  15. PMID 16627048
    .
  16. PMID 31718277
    .
  17. ABIM Foundation, American Society of Nuclear Cardiology, archived from the original
    (PDF) on April 16, 2012, retrieved August 17, 2012
  18. PMID 17692738
    .

External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Left_ventricular_hypertrophy&oldid=1195806084"