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Pathological versus physiological left ventricular hypertrophy: a review
1Department of Pediatrics and the Crippled Children's Foundation Research Center, University of Tennessee, Memphis 38103, USA.
Insights
Left ventricular hypertrophy is a risk for heart events, but its causes and whether it’s quantity or quality that matters are unclear. This review explores pathological and physiological states, patterns, and biochemical factors influencing this condition.
Area of Science:
- Cardiology
- Pathophysiology
- Biochemistry
Background:
- Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbid events.
- Primary mechanisms stimulating LVH remain largely unknown.
- Conflicting theories exist regarding LVH as a continuous variable versus a risk determined by myocardial structure and function.
Purpose of the Study:
- To review pathological and physiological states of left ventricular hypertrophy.
- To examine hypertrophy patterns and their structural and functional characteristics.
- To discuss biochemical factors influencing myocardial remodeling in LVH.
Main Methods:
- Literature review of epidemiological and morphological studies.
- Analysis of criteria for pathological and physiological LVH.
- Exploration of myocardial adaptations to imposed loads.
Main Results:
- Hemodynamic overloading is not the sole determinant of left ventricular structure and function in hypertensive patients.
- Pathological and physiological LVH states are defined by imposed load and myocardial adaptations.
- Myocardial quality and function, not just mass, are implicated in cardiovascular risk.
Conclusions:
- Understanding the diverse states, patterns, and biochemical influences of LVH is crucial for assessing cardiovascular risk.
- Further research into the primary mechanisms of LVH is warranted.
- The role of myocardial structure and function, beyond mass, requires further elucidation.
Abstract:
Left ventricular hypertrophy is recognized as an independent risk factor for cardiovascular morbid events. The primary mechanisms responsible for stimulating it are unknown. Epidemiological theories suggest that left ventricular hypertrophy is a continuous variable with no threshold, while morphological studies argue that it is the structure, or quality, and function of the myocardium (and therefore non-continuous), not the quantity of the myocardial mass, that poses the cardiovascular risk. Although left ventricular hypertrophy has been classically viewed as an adaptive response of the cardiovascular system to an imposed load, it has been demonstrated that haemodynamic overloading in selected hypertensive patients is not the sole determinant of left ventricular structure and function. Pathological and physiological states of left ventricular hypertrophy have been described primarily using criteria focusing on normal chamber performance and oxygen delivery as well as the reversibility of the hypertrophy once the overload is removed. Both states are also defined by the nature of the imposed load and the resulting myocardial adaptations. This review addresses the pathological and physiological states of left ventricular hypertrophy, the hypertrophy patterns, and the corresponding structural and functional characteristics, together with some of the biochemical factors thought to influence remodelling.