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Is left ventricular hypertrophy regression important? Does the tool used to detect it matter?
Wadih Nadour1, Robert W W Biederman
1Division of Internal Medicine and Cardiology, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Insights
Left ventricular hypertrophy (LVH) impacts cardiovascular prognosis. Cardiovascular magnetic resonance imaging (CMR) offers an accurate, noninvasive method to assess LVH and guide treatment goals for improved outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Disease
Background:
- Left ventricular hypertrophy (LVH) is linked to adverse cardiovascular prognosis.
- Current noninvasive tools for LVH assessment are limited, hindering timely therapy initiation and regression monitoring.
- Accurate LVH quantification is crucial for effective cardiovascular risk management.
Purpose of the Study:
- To review current imaging modalities for assessing LVH and its regression.
- To highlight cardiovascular magnetic resonance imaging (CMR) as the gold standard for LVH evaluation.
- To establish a quantitative goal for left ventricular mass reduction following antihypertensive therapy.
Main Methods:
- Comprehensive review of existing literature on LVH imaging techniques.
- Focus on cardiovascular magnetic resonance imaging (CMR) for its accuracy, reproducibility, and cost-effectiveness.
- Analysis of Framingham data to inform target LV mass reduction goals.
Main Results:
- Cardiovascular magnetic resonance imaging (CMR) demonstrates ease, efficiency, and accuracy in delineating LVH.
- CMR is presented as a superior noninvasive tool compared to existing methods for LVH assessment.
- A novel goal for left ventricular mass reduction in grams is proposed for echocardiography and CMR.
Conclusions:
- Cardiovascular magnetic resonance imaging (CMR) is a reliable and accessible tool for evaluating left ventricular hypertrophy (LVH).
- Regression of LVH is important for improving cardiovascular outcomes.
- The proposed quantitative reduction goal aims to optimize antihypertensive therapy and reduce cardiovascular risk.
Abstract:
Left ventricular hypertrophy (LVH) has been demonstrated to define an adverse cardiovascular prognosis. However, due to poor noninvasive tools in which to accurately define LVH, the clinical manifestations dictate an inexact manner in which to either initiate therapy or to gauge the success of LVH regression. Herein, the authors define the current state of imaging modalities available to interrogate LVH and its regression, but concentrating chiefly on the "gold standard" of cardiovascular magnetic resonance imaging (CMR). The authors review the data demonstrating the importance of LVH regression. Additionally, they highlight the strengths and weaknesses of CMR via several pinnacle studies that demonstrate the ease, efficiency, and accuracy of this new noninvasive reproducible and available tool to relatively inexpensively delineate LVH. Finally, upon pharmacologic administration of an antihypertensive regimen, the authors, for the first time, define a goal of left ventricular mass reduction (in grams) for echocardiography and CMR based in part on Framingham data aiming at improving cardiovascular risk.
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