Malignant Left Ventricular Hypertrophy: a Dynamic High-Risk Pre-Heart Failure Phenotype

To review malignant left ventricular hypertrophy (LVH) as a dynamic, higher-risk phenotype within Stage B/pre-heart failure (HF), with a focus on its underlying biology, prognostic significance, and potential modifiability.

The malignant LVH phenotype has been newly recognized to be associated with atrial fibrillation, stroke, and cognitive impairment. Recent data also suggest that intensive BP lowering may reduce incident malignant LVH and potentially promote phenotype regression. Other novel approaches that have been shown to reduce adverse remodeling in related populations include direct antifibrotic agents, incretin-analogues, and repurposing known HF therapies. The identification of malignant LVH with a structural and biomarker-based framework may identify a subgroup at particularly high risk for progression to symptomatic HF or CV death.