New approaches to the assessment of left ventricular hypertrophy

In hypertension, Left ventricular hypertrophy 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. For this reason most international guidelines recommend the assessment of cardiac target organ damage in hypertensive patients for cardiovascular risk stratification. It is therefore of great importance to keep in mind the strengths and weakness of the different available methods for LVH assessment.Several methods are currently available for the assessment of LVH; however the various techniques differ in cost, availability, sensitivity and specificity. Due to its wide availability and its low cost, eLectrocardiography should be part of all routine assessment of subjects with high blood pressure; however, despite its good specificity, the sensitivity for LVH detection is low. Several other methods have been proposed for LVH detection. Cardiac magnetic resonance imaging allows 3D reconstruction of the heart with high spatial resolution; however its main limitation is represented by the relatively low availability and by its costs. Echocardiography certainly represents a valuable method for the detection of LVH in hypertensive patients, due to its wide availability and its relatively low cost. The main limitations of the technique are represented by the lower spatial resolution and reproducibility in comparison with magnetic resonance. The development of new matrix-array transducers and new software for 3D reconstruction with echocardiography make this approach particularly promising for the future; in the meantime, standard echocardiography, widely available and with low cost, will probably remain the most used tool for the evaluation of left ventricular structure and function in hypertension.