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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
06:34

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Published on: October 28, 2020

A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study

Michel G Khouri1, Ronald M Peshock, Colby R Ayers

  • 1Donald W. Reynolds Cardiovascular Clinical Research Center and Divisions of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA.

Circulation. Cardiovascular Imaging
|January 12, 2010
PubMed

Insights

A new 4-tiered classification for left ventricular hypertrophy (LVH) refines diagnosis. This system better identifies patients with indeterminate LVH, revealing improved cardiac function and lower biomarker levels compared to traditional methods.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomarkers

Background:

  • Traditional classification of left ventricular hypertrophy (LVH) into concentric or eccentric patterns is based on LV wall thickness to chamber dimension ratios.
  • A novel 4-tiered classification is proposed, utilizing LV concentricity and indexed LV end-diastolic volume (EDV).

Purpose of the Study:

  • To introduce and validate a new 4-tiered classification system for left ventricular hypertrophy (LVH).
  • To re-evaluate the traditional classification of LVH based on cardiac MRI findings and patient biomarkers.

Main Methods:

  • Cardiac MRI was performed on 2803 subjects to assess LV mass, concentricity, and indexed EDV.
  • LVH was defined by increased LV mass/height(2.7).
  • Four geometric patterns were identified: thick, dilated, both thick and dilated, and indeterminate hypertrophy.

Main Results:

  • Out of 895 subjects with LVH, 361 had "thick hypertrophy," 53 had "dilated hypertrophy," 13 had "both thick and dilated hypertrophy," and 468 had "indeterminate hypertrophy."
  • Subjects with "both thick and dilated hypertrophy" showed lower LV ejection fraction and higher NT-pro-BNP and BNP levels compared to "isolated thick hypertrophy."
  • Subjects with "dilated hypertrophy" had lower LV ejection fraction and higher troponin T, NT-pro-BNP, and BNP levels than "indeterminate hypertrophy."
  • The "indeterminate hypertrophy" group exhibited higher LV mass but also better LV ejection fraction and normal biomarker levels compared to subjects without LVH.

Conclusions:

  • The proposed 4-tiered classification system effectively subcategorizes concentric and eccentric LVH into distinct geometric patterns.
  • A significant number of patients previously classified under eccentric LVH can be reclassified into an "indeterminate hypertrophy" subgroup.
  • This indeterminate subgroup demonstrates superior LV function and comparable cardiac stress biomarker levels to those without LVH, suggesting a need for revised diagnostic criteria.
Abstract

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