Left Ventricular Functional Alterations across Types and Severity of Hypertrophy

Introduction: Left ventricular hypertrophy (LVH) increases the risk of chronic heart failure. Even with preserved ejection fraction (EF), mortality remains significant. Impaired systolic contraction and abnormal diastolic filling may contribute to heart failure progression. Objective: To evaluate changes in left ventricular (LV) function based on LVH type and severity. Methods: Retrospective analysis of 518 echocardiography-confirmed LVH patients, categorized by wall thickness, LV mass index, and relative wall thickness into mild, moderate, severe, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. Comparisons were made with 707 healthy subjects from a prior study. Echocardiographic and exercise tolerance data were analyzed. Results: LV function markers of LV systolic and diastolic dysfunction - including EF, global longitudinal strain (GLS), treadmill test metabolic equivalents, mitral annular systolic velocity (MV s'), tricuspid systolic velocity (TV s'), and tricuspid annular plane systolic excursion (TAPSE) - declined progressively with increasing LVH severity. Conversely, indices of elevated filling pressure (E/e') and pulmonary pressure (right ventricular systolic pressure [RVSP]) increased with increasing LVH severity. Conclusion: Parameters of LV function such as left ventricular EF, GLS, effort tolerance, MVs', and E/e' get progressively deranged as LV hypertrophy deteriorates. Simultaneous derangement of RV function is observed in TAPSE and TVs'. Pulmonary artery pressure by RVSP increases with increasing severity of LVH. Eccentric LVH resembles severe LVH, while concentric remodeling resembles mild LVH. GLS detects early LV dysfunction and predicts effort tolerance, even in mild LVH.