fbpx
Cardioserv Logo
Watch now!
Written by Judith Buckland, RDCS, FASE, MBA and Andrea Fields, MHA, RDCS

Understanding LVH Part 1: Concentric, Eccentric and Concentric Remodeling

Last month was designated American Heart Month to raise awareness of cardiovascular disease, the leading fatality of Americans. AHA encourages our patients to take control over understanding their risk factors of heart disease including knowing their numbers related to blood pressure. Untreated hypertension can have a long-term effect on the heart causing hypertensive heart disease, which can include coronary heart disease (CAD), left ventricular hypertrophy (LVH) and hypertrophic cardiomyopathy (HCM).

Echocardiography plays a major role in the prognostic evaluation of hypertension (HTN). The main contribution of echo in the management of hypertension is the assessment of left ventricular mass (LVM). In this blog we describe left ventricular hypertrophy (LVH) and identify the different categories of concentric, eccentric and concentric remodeling. In Part 2 of the blog we will elaborate on LV Mass (LVM) and Relative Wall Thickness (RWT). We will provide step-by-step instructions on how to obtain these values during a routine echocardiogram.

What is LVH?

Left ventricular hypertrophy is a form of cardiac remodeling that causes the heart wall muscle to thicken, which leads to an increase in LV mass (LVM). There are different sub-categories that fall into the diagnosis of LVH, which includes concentric, eccentric and concentric remodeling.

There are key factors that play a major role in determining the presence of LVH:

We cannot cover all of these within this blog series but it’s important to know that the heart size is influenced by body size. Remember:

  • Men have larger hearts than women
  • Athletes have larger hearts than non-athletes
  • Obese patients have larger hearts than non-obese patients

Let’s briefly talk about what occurs as the heart enlarges.

Enlarged hearts:

  •  ↑ wall (fibre) stress = ↑ wall thickness = ↑ LV size (radius & volume)
  • In patients with chronic high systolic blood pressure the heart wall will become thickened due to the wall stress from hypertension

Concentric LVH

Concentric LVH is the result of the heart adapting to high systemic pressure overload caused by hypertension or other diseases such as aortic stenosis. Peripheral resistance is increased. Concentric LVH affects both men and women, regardless of age. It is associated with changes in LV geometry, diastolic function, longitudinal and radial myocardial function and atrial size.

The hallmark echocardiographic signs of concentric LVH include:

  • Global increased wall thickness
  • Normal LV cavity size
  • Increased LVM (Left ventricular mass)
  • Increased RWT (Relative Wall thickness)

Eccentric LVH

On the other hand, eccentric hypertrophy deals with volume overload due to a significant valvular regurgitation issue or high cardiac index. The systemic pressures will be normal and the peripheral resistance is not increased. This category of patients will have changes in both diastolic function and the longitudinal and radial function. They will show to have either a low normal or a mildly impaired systolic function due to having chronic volume overload. The shape of the LV will change, becoming more spherical since the LV will be enlarged..

The hallmark echocardiographic signs of eccentric LVH include:

  • Normal LV wall thickness
  • Increased LV cavity size
  • Increased LVM (Left ventricular mass)
  • Decreased RWT (Relative Wall thickness)

Concentric Remodeling

Concentric remodeling is the late stage response to LV hypertrophy; caused by either chronic pressure, volume overload or a MI (which is commonly associated with CAD, but can be due to longstanding hypertension, especially untreated). Concentric remodeling will demonstrate systolic dysfunction along with changes in the LV geometry.  The shape of the LV changes and becomes more rounded, rather than bullet shaped.  You will notice the rapid degradation of diastolic dysfunction and loss of radial and longitudinal function.

The hallmark echocardiographic signs of concentric remodeling include:

  • Usually increased LV wall thickness
  • Normal or small LV cavity size
  • Normal LVM (Left ventricular mass)
  • Increased RWT (Relative Wall thickness)

Remember

  • Concentric LVH = Pressure Overload (BP)
  • Eccentric LVH = Volume Overload (Regurgitation)
  • Remodeling = CHRONIC pressure & volume overload or MI

Conclusion

Our goal this week was to provide you with a better understanding of the pathophysiology behind the various categories of LVH. This table will provide you with a better understanding of the echocardiographic findings found in the subcategories of left ventricular hypertrophy (LVH). We discussed how LV mass (LVM) and relative wall thickness (RWT) plays a role in identifying the categories of LVH. But what is LVM and RWT?? How do we obtain them? In the second part of our LVH blog series, we will provide step-by step instructions on how to obtain these values.

References

  • Alam, S. (n.d.). The Edinburgh Cardiology Imaging Website. Retrieved March 01, 2017, from http://webservice1.mvm.ed.ac.uk/imaging/demo/cases/cardiac-amyloid-echo.html
  • Marwick, T. H., PhD, Gillebert, T. C., MD, & G. A., MD. (2015). Recommendations on the Use of Echocardiography in Adult Hypertension. JASE,28(7), 1-12. Retrieved March 1, 2017, from http://asecho.org/wordpress/wp-content/uploads/2015/07/2015_Hypertension.pdf
  • Lang, R. M., MD, Badano, L. P., MD, & Mor-Avi, V., PhD. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. JASE, 28(1), 1-53. Retrieved March 1, 2017, from http://asecho.org/wordpress/wp-content/uploads/2015/01/ChamberQuantification2015.pdf

 

adult echoconcentric LVHconcentric remodelingeccentric LVHechoechocardiographyleft ventricular hypertrophyLVH

Our Services

LET US KNOW WHAT YOU THINK...

Tadesse Gemechuhow d
how do we measure relative wall thickness
Cardioserv
We will provide step-by step instructions on how to obtain relative wall thickness (RWT) and LV mass (LVM) in next weeks blog! Be sure to sign up for our newsletter to receive our blogs and other cardiovascular news straight in your inbox.
David Diamond
Keep these coming Judith. I have enjoyed your articles and find them very informative.
Vicky turla
thank you
Catalin Buzulescu
Interesting to emphasize and remember concentric and excentric LVH. Thank You!
Ahmed
Thanks a lot for this information
Lisbeth Robelo
Thank you for refreshing my memory on LVH.
Daniela Solomon
Thanks a lot.
Maryam umar Alhassan
It really educative, I want to know more on concentric remodeling, cos am a victim. Thnx
Maryam umar Alhassan
I enjoyed the topic, is very educative. Thnx
geresu gebeyehu
it's so much interesting to gain additional point in this discussion
Sk Kamal Uddin
Excellent
[email protected]
More information about concentric remodelling,Treatment and drug used.How long is the treatment to reverse
Niels
Hi, when it comes to reporting - I am still confused as to what to write: 'Hypertrophy' in the world of the pathologist strictly just means 'increased weight', and this can occur both through concentric LVH with wall thickening as well as eccentric LVH without wall thickening. The result can be the same, when you put the diseased heart on the scale - its weight is increased. In echo reporting though 'hypertrophy' seems to be often synonymously used for 'wall thickening', right?! Wouldn't it thus be more precise to report 'wall thickening' instead of 'hypertrophy' (if this is what you want to describe) - or is it wide-spread accepted general understanding that the reporting echocardiographer actually means 'wall thickening' when using the word 'hypertrophy' in most circumstances? Grateful for your advice!
ALISON
Nice!
Nasser
Thank for your information I enjoyed reading them
Noura
Thanks for this nice informations I really enjoy it.
DR SRIKANTH NAYAR
I WOULD LIKE TO RECEIVE NEWSLETTER AND WOULD LIKE TO HAVE MORE KNOWLEDGE ON LV MASS INDEX
Cardioserv
Thanks for your interest! Once you sign up for our blogs you will automatically receive our newsletter. We will add your request for LV mass index to our list so stay tuned! :)
Click here to cancel reply.

Your email will not be displayed.

Required *

Blog
Sign Up

Accreditation
services

Accreditation Help
Online Echo CMEs
Echo Accreditation Software
Free
Consultation

Search
for

Blog
Categories

All Categories
Accreditation
CardioServ
Case Studies
Echocardiography
Industry Updates
Nuclear Medicine
Quality Improvement
Vascular Ultrasound

Blog
Archive

  • 2024
    • May
    • Apr
    • Mar
    • Feb
    • Jan
  • 2023
    • Jul
    • Jun
  • 2020
    • Oct
    • May
    • Apr
    • Mar
  • 2019
    • Nov
    • Oct
    • Sep
    • Aug
    • Jul
    • Jun
    • Apr
    • Mar
    • Feb
    • Jan
  • 2018
    • Dec
    • Nov
    • Oct
    • Sep
    • Aug
    • Jul
    • Jun
    • May
    • Apr
    • Mar
    • Feb
    • Jan
  • 2017
    • Dec
    • Nov
    • Oct
    • Sep
    • Aug
    • Jul
    • Jun
    • Apr
    • Mar
    • Feb
    • Jan
  • 2016
    • Dec
    • Oct
    • Aug
    • Jul
    • Jun
    • Apr
    • Mar
    • Feb
    • Jan
  • 2015
    • Dec
    • Nov
    • Oct
    • Sep

Tags
Used

Show tags Hide tags
Need Help? Share
Need Help?

4617作文网怎么算生辰八字命格属鼠人起名字宜用字家居厂起名字鼠宝宝姓郭起名字大全姓周怎么起名字好听怎么算婚姻命公司测名周易店铺开鹅饭店起名大全上海周易预测用父母的姓名起名字男孩取名字周易取表字网站定字起名2018年 宝宝起名起名大师姓名测试生态农业公司起名大全婴儿屁眼周围容易红2020王姓女孩起名在线起名周易起名周公解梦梦到洗脚命格测算可信吗蛋糕起什么名字好呢男人姓王起名大全洋气起名字4个字的的周易40卦详解周易推算生辰八字在线给宝宝起名字吗称骨算命八字算终身周易五行缺什么名字免费算命网取名命格计算淀粉肠小王子日销售额涨超10倍罗斯否认插足凯特王妃婚姻让美丽中国“从细节出发”清明节放假3天调休1天男子给前妻转账 现任妻子起诉要回网友建议重庆地铁不准乘客携带菜筐月嫂回应掌掴婴儿是在赶虫子重庆警方辟谣“男子杀人焚尸”国产伟哥去年销售近13亿新的一天从800个哈欠开始男孩疑遭霸凌 家长讨说法被踢出群高中生被打伤下体休学 邯郸通报男子持台球杆殴打2名女店员被抓19岁小伙救下5人后溺亡 多方发声单亲妈妈陷入热恋 14岁儿子报警两大学生合买彩票中奖一人不认账德国打算提及普京时仅用姓名山西省委原副书记商黎光被逮捕武汉大学樱花即将进入盛花期今日春分张家界的山上“长”满了韩国人?特朗普谈“凯特王妃P图照”王树国3次鞠躬告别西交大师生白宫:哈马斯三号人物被杀代拍被何赛飞拿着魔杖追着打315晚会后胖东来又人满为患了房客欠租失踪 房东直发愁倪萍分享减重40斤方法“重生之我在北大当嫡校长”槽头肉企业被曝光前生意红火手机成瘾是影响睡眠质量重要因素考生莫言也上北大硕士复试名单了妈妈回应孩子在校撞护栏坠楼网友洛杉矶偶遇贾玲呼北高速交通事故已致14人死亡西双版纳热带植物园回应蜉蝣大爆发男孩8年未见母亲被告知被遗忘张立群任西安交通大学校长恒大被罚41.75亿到底怎么缴沈阳一轿车冲入人行道致3死2伤奥运男篮美国塞尔维亚同组周杰伦一审败诉网易国标起草人:淀粉肠是低配版火腿肠外国人感慨凌晨的中国很安全男子被流浪猫绊倒 投喂者赔24万杨倩无缘巴黎奥运男子被猫抓伤后确诊“猫抓病”春分“立蛋”成功率更高?记者:伊万改变了国足氛围奥巴马现身唐宁街 黑色着装引猜测

4617作文网 XML地图 TXT地图 虚拟主机 SEO 网站制作 网站优化