Left Ventricular Geometry and Hypertrophy in Cardiovascular Health

The left ventricle (LV) adapts to haemodynamic demands by altering its size, shape and wall thickness, a process collectively referred to as geometric remodelling. In response to pressure overload, the ventricle may develop concentric remodelling or concentric hypertrophy, characterised by increased wall thickness relative to cavity size. Volume overload tends to produce eccentric hypertrophy, marked by chamber dilation alongside mass gain. These geometric patterns influence cardiac function, arrhythmic risk and long-term outcomes. Quantitative measures such as left ventricular mass index (LVMI) and relative wall thickness (RWT) underpin classification schemes, while emerging metrics like global wall thickness (GT) and the sphericity index refine risk stratification. Abnormal geometry has been linked to heart failure with preserved ejection fraction, atrial fibrillation, sudden arrhythmic death and impaired organ perfusion. Advances in imaging and proteomics are revealing sex-specific pathways and molecular drivers of remodelling, opening avenues for targeted prevention and therapy in diverse patient populations.

Research from Nature Portfolio

Contemporary magnetic resonance studies have introduced global wall thickness (GT) as a novel, easily derived metric from LV mass and end-diastolic volume. In patients undergoing cardiac magnetic resonance, GT and its body size-indexed form (GTI) demonstrated strong prognostic value, complementing the predictive power of LVMI for death and heart failure hospitalisation. The combined use of GT and LVMI enabled accurate classification into normal geometry, concentric remodelling, concentric hypertrophy and eccentric hypertrophy, each associated with progressively worse outcomes.

In a large echocardiographic registry, patterns of LV geometry were correlated with the prevalence of atrial fibrillation. Patients stratified by LVMI and RWT into normal geometry, concentric remodelling, concentric hypertrophy and eccentric hypertrophy exhibited stepwise increases in left atrial volume and atrial fibrillation rates. These findings underscore the link between structural remodelling, atrial enlargement and arrhythmic vulnerability, and highlight the importance of integrated imaging and electrocardiographic assessment in risk evaluation.

Left Ventricular Geometry and Hypertrophy in Cardiovascular Health publication trend

The graph below shows the total number of articles in left ventricular geometry and hypertrophy in cardiovascular health across all publications each year (not limited to Nature Index journals).

Technical terms

Left ventricular mass index (LVMI): LV mass adjusted for body surface area to quantify hypertrophy.

Relative wall thickness (RWT): Ratio of wall thickness to cavity diameter, used to classify geometric patterns.

Concentric remodelling: Increased wall thickness without significant mass gain, reflecting pressure adaptation.

Concentric hypertrophy: Simultaneous increase in wall thickness and mass, with preserved or reduced cavity size.

Eccentric hypertrophy: Increased LV mass accompanied by chamber dilation, reflecting volume overload.

Global wall thickness (GT): Novel metric derived from LV mass and end-diastolic volume to assess wall thickness uniformly.

Sphericity index: Measure of LV shape, defined as the ratio of LV volume to the volume of a sphere with the same long-axis diameter.

References

1. Plasma Proteomic Patterns Show Sex Differences in Early Concentric Left Ventricular Remodeling. Circulation Heart Failure (2023).
2. Prognostic utility and characterization of left ventricular hypertrophy using global thickness. Scientific Reports (2023).
3. Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Scientific Reports (2018).
4. Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance (2016).
5. Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification. Frontiers in Cardiovascular Medicine (2021).