[Left ventricular hypertrophy: favorable or unfavorable compensatory mechanisms?]

Myocardial hypertrophy serves, at least initially, a compensatory function to maintain wall stress and oxygen consumption within the normal range in hemodynamic overload of the ventricle which preserves systolic cardiac performance. These favorable changes of the myocardium with regard to systolic pump capacity of the left ventricle against an increased load, leads early in this adaptive process to unfavorable hemodynamic changes. As a result of these functional cardiac consequences of left ventricular hypertrophy develops impaired diastolic filling with diminished diastolic dimensions. Left ventricular hypertrophy is per se associated with poor prognosis due to an increased risk of sudden death and the development of congestive heart failure. Subendocardial ischemia may play a major role in the genesis of these events. As a consequence, therapeutic interventions should not only decrease the hemodynamic load of the left ventricle but also lead to a regression of left ventricular hypertrophy which is an independent risk factor in hypertension.