Materiały źródłowe

• #1 Left Ventricular Hypertrophy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557534/

  According to the American Society of Echocardiography and/European Association of Cardiovascular Imaging, LVH is defined as an increased left ventricular mass index (LVMI) to greater than 95 g/m in women and increased LVMI to greater than 115 g/m in men. […] The management of LVH depends on the etiology. Treatment involves lifestyle changes, and depending upon the cause, may include medication, surgery, and an implantable device for the prevention of sudden cardiac death. LVH treatment should be aggressive because patients with LVH are at the highest risk for cardiovascular events and mortality. […] The presence of LVH forecasts an increased risk of cardiovascular morbidity and mortality, even after adjustment for major cardiovascular risk factors such as age, smoking, obesity dyslipidemia, blood pressure, and diabetes. This means that LVH is an independent risk factor for cardiovascular disease. […] Once LVH is developed, it puts the patient at significant risk of developing myocardial ischemia and infarction, heart failure, dysrhythmias, or even sudden death.

• #2 Left ventricular hypertrophy: Clinical findings and ECG diagnosis – UpToDate

  https://www.uptodate.com/contents/left-ventricular-hypertrophy-clinical-findings-and-ecg-diagnosis

  Left ventricular hypertrophy (LVH) refers to an increase in the size of myocardial fibers in the main cardiac pumping chamber. Such hypertrophy is usually the response to a chronic pressure or volume load. […] The electrocardiogram (ECG) is a useful but imperfect tool for detecting LVH. The utility of the ECG relates to its being relatively inexpensive and widely available. The limitations of the ECG relate to its moderate sensitivity or specificity depending upon which of the many proposed sets of diagnostic criteria are applied. Therefore, because of these ECG limitations, LVH is most reliably identified on imaging with either echocardiography or cardiac magnetic resonance imaging.

• #3 Left Ventricular Hypertrophy (LVH) • LITFL • ECG Library Diagnosis

  https://litfl.com/left-ventricular-hypertrophy-lvh-ecg-library/

  There are numerous voltage criteria for diagnosing LVH, summarised below. The most commonly used are the Sokolow-Lyon criteria: S wave depth in V1 + tallest R wave height in V5 or V6 35 mm. Voltage criteria must be accompanied by non-voltage criteria to be considered diagnostic of LVH. […] Voltage criteria alone are not diagnostic of LVH. ECG changes are an insensitive means of detecting LVH (patients with clinically significant left ventricular hypertrophy seen on echocardiography may still have a relatively normal ECG). […] The strain pattern just further confirms LVH. Its presence is associated with a poor prognosis.

• #4 ECG in left ventricular hypertrophy (LVH): criteria and implications – The Cardiovascular

  https://ecgwaves.com/topic/ecg-left-ventricular-hypertrophy-lvh-clinical-characteristics/

  The most common causes of left ventricular hypertrophy are aortic stenosis, aortic regurgitation, hypertension, cardiomyopathy and coarctation of the aorta. There are several ECG indexes, which generally have high diagnostic specificity but low sensitivity. These indexes were developed several decades ago but they are still in use in clinical practice. It should be noted that there are newer, more complicated, indexes that are utilized in modern ECG machines but the sensitivity and specificity are only negligibly better than the old indexes. […] Sokolow-Lyons index is the most used index, despite having the lowest sensitivity (20%) of all indexes. The specificity is high (85%). […] Sensitivity 42%, specificity 95% […] Presumably the best index. Sensitivity 51%, specificity 95%. […] Romhilt-Estes index, which is point-based, has been reported to have a sensitivity of 60%. 4 points make LVH probable. 5 points make LVH very likely.

• #5 Left Ventricular Hypertrophy (LVH) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/left-ventricular-hypertrophy-review

  Left ventricular hypertrophy can be diagnosed on ECG with good specificity. […] Through many studies, multiple criteria have been developed to diagnose LVH on an ECG; they are listed below. […] Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is greater than 28 millimeters in males or greater than 20 mm in females, LVH is present. […] Modified Cornell Criteria: Examine the R wave in aVL. If the R wave is greater than 12 mm in amplitude, LVH is present. […] Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is greater than 35 mm, LVH is present. […] Romhilt-Estes LVH Point Score System: If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.

• #6 Left Ventricular Hypertrophy (LVH) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/left-ventricular-hypertrophy-review

  Left ventricular hypertrophy can be diagnosed on ECG with good specificity. […] Through many studies, multiple criteria have been developed to diagnose LVH on an ECG; they are listed below. […] Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is greater than 28 millimeters in males or greater than 20 mm in females, LVH is present. […] Modified Cornell Criteria: Examine the R wave in aVL. If the R wave is greater than 12 mm in amplitude, LVH is present. […] Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is greater than 35 mm, LVH is present. […] Romhilt-Estes LVH Point Score System: If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.

• #7 ECG in left ventricular hypertrophy (LVH): criteria and implications – The Cardiovascular

  https://ecgwaves.com/topic/ecg-left-ventricular-hypertrophy-lvh-clinical-characteristics/

  The most common causes of left ventricular hypertrophy are aortic stenosis, aortic regurgitation, hypertension, cardiomyopathy and coarctation of the aorta. There are several ECG indexes, which generally have high diagnostic specificity but low sensitivity. These indexes were developed several decades ago but they are still in use in clinical practice. It should be noted that there are newer, more complicated, indexes that are utilized in modern ECG machines but the sensitivity and specificity are only negligibly better than the old indexes. […] Sokolow-Lyons index is the most used index, despite having the lowest sensitivity (20%) of all indexes. The specificity is high (85%). […] Sensitivity 42%, specificity 95% […] Presumably the best index. Sensitivity 51%, specificity 95%. […] Romhilt-Estes index, which is point-based, has been reported to have a sensitivity of 60%. 4 points make LVH probable. 5 points make LVH very likely.

• #8 Left Ventricular Hypertrophy (LVH) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/left-ventricular-hypertrophy-review

  Left ventricular hypertrophy can be diagnosed on ECG with good specificity. […] Through many studies, multiple criteria have been developed to diagnose LVH on an ECG; they are listed below. […] Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is greater than 28 millimeters in males or greater than 20 mm in females, LVH is present. […] Modified Cornell Criteria: Examine the R wave in aVL. If the R wave is greater than 12 mm in amplitude, LVH is present. […] Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is greater than 35 mm, LVH is present. […] Romhilt-Estes LVH Point Score System: If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.

• #9 Left Ventricular Hypertrophy (LVH) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/left-ventricular-hypertrophy-review

  Left ventricular hypertrophy can be diagnosed on ECG with good specificity. […] Through many studies, multiple criteria have been developed to diagnose LVH on an ECG; they are listed below. […] Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is greater than 28 millimeters in males or greater than 20 mm in females, LVH is present. […] Modified Cornell Criteria: Examine the R wave in aVL. If the R wave is greater than 12 mm in amplitude, LVH is present. […] Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is greater than 35 mm, LVH is present. […] Romhilt-Estes LVH Point Score System: If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.

• #10 ECG Learning Center – An introduction to clinical electrocardiography

  https://ecg.utah.edu/lesson/8

  („diagnostic”, 5 points; „probable”, 4 points) […] (sensitivity = 22%, specificity = 95%) […] Other Voltage Criteria for LVH: […] Limb-lead voltage criteria: […] Chest-lead voltage criteria: […] Specific ECG features (assumes normal calibration of 1 mV = 10 mm): […] ST segment depression and T wave inversion in right precordial leads is usually seen in severe RVH such as in pulmonary stenosis and pulmonary hypertension. […] In the presence of LAE any one of the following suggests this diagnosis: […] Other suggestive ECG findings: […] Criteria for LVH and RVH both met […] LVH criteria met and RAD or RAE present.

• #11 Left Ventricular Hypertrophy (LVH) • LITFL • ECG Library Diagnosis

  https://litfl.com/left-ventricular-hypertrophy-lvh-ecg-library/

  There are numerous voltage criteria for diagnosing LVH, summarised below. The most commonly used are the Sokolow-Lyon criteria: S wave depth in V1 + tallest R wave height in V5 or V6 35 mm. Voltage criteria must be accompanied by non-voltage criteria to be considered diagnostic of LVH. […] Voltage criteria alone are not diagnostic of LVH. ECG changes are an insensitive means of detecting LVH (patients with clinically significant left ventricular hypertrophy seen on echocardiography may still have a relatively normal ECG). […] The strain pattern just further confirms LVH. Its presence is associated with a poor prognosis.

• #12 Left ventricular hypertrophy: Clinical findings and ECG diagnosis – UpToDate

  https://www.uptodate.com/contents/left-ventricular-hypertrophy-clinical-findings-and-ecg-diagnosis

  Left ventricular hypertrophy (LVH) refers to an increase in the size of myocardial fibers in the main cardiac pumping chamber. Such hypertrophy is usually the response to a chronic pressure or volume load. […] The electrocardiogram (ECG) is a useful but imperfect tool for detecting LVH. The utility of the ECG relates to its being relatively inexpensive and widely available. The limitations of the ECG relate to its moderate sensitivity or specificity depending upon which of the many proposed sets of diagnostic criteria are applied. Therefore, because of these ECG limitations, LVH is most reliably identified on imaging with either echocardiography or cardiac magnetic resonance imaging.

• #13 ECG in left ventricular hypertrophy (LVH): criteria and implications – The Cardiovascular

  https://ecgwaves.com/topic/ecg-left-ventricular-hypertrophy-lvh-clinical-characteristics/

  Large R-waves in left-sided leads (V5, V6, I and aVL) and deep S-waves in right-sided leads (V1, V2) indicate that the vector of the left ventricle is amplified. […] Secondary ST-T changes in left-sided leads Left ventricular hypertrophy is often accompanied by J point depression, downsloping ST segment and inverted (asymmetric) T-waves in the left-sided leads. […] Prolonged QRS duration Because it takes a longer time to depolarize a larger myocardial mass, the QRS duration may be slightly prolonged. […] Left atrial enlargement (P mitrale) may develop because LVH affects the hemodynamics of the left atrium. […] Left axis deviation is common in LVH. […] A slight prolongation of the QT (QTc) interval is frequently seen. […] All indexes are based partly on QRS amplitudes which may appear logical but it is actually a rather unreliable variable because it is affected by a range of factors not related to ventricular mass.

• #14 Left Ventricular Hypertrophy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557534/

  Left ventricular hypertrophy (LVH) is a condition in which an increase in left ventricular mass occurs secondary to an increase in wall thickness, an increase in left ventricular cavity enlargement, or both. This activity reviews the normal limits of left ventricle mass and the criterion defined by the American Society of Echocardiography in establishing the diagnosis of left ventricular hypertrophy. […] Left ventricular hypertrophy (LVH) is a condition in which there is an increase in left ventricular mass, either due to an increase in wall thickness or due to left ventricular cavity enlargement, or both. Most commonly, the left ventricular wall thickening occurs in response to pressure overload, and chamber dilatation occurs in response to the volume overload. […] An echocardiogram is the test of choice in establishing the diagnosis of LVH. Its sensitivity is significantly higher than ECG, and the test can also diagnose other abnormalities such as left ventricular dysfunction (both systolic as well as diastolic) and valvular heart disease.

• #15 Left Ventricular Hypertrophy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557534/

  Left ventricular hypertrophy (LVH) is a condition in which an increase in left ventricular mass occurs secondary to an increase in wall thickness, an increase in left ventricular cavity enlargement, or both. This activity reviews the normal limits of left ventricle mass and the criterion defined by the American Society of Echocardiography in establishing the diagnosis of left ventricular hypertrophy. […] Left ventricular hypertrophy (LVH) is a condition in which there is an increase in left ventricular mass, either due to an increase in wall thickness or due to left ventricular cavity enlargement, or both. Most commonly, the left ventricular wall thickening occurs in response to pressure overload, and chamber dilatation occurs in response to the volume overload. […] An echocardiogram is the test of choice in establishing the diagnosis of LVH. Its sensitivity is significantly higher than ECG, and the test can also diagnose other abnormalities such as left ventricular dysfunction (both systolic as well as diastolic) and valvular heart disease.

• #16 Left ventricular hypertrophy – Wikipedia

  https://en.wikipedia.org/wiki/Left_ventricular_hypertrophy

  Left ventricular hypertrophy (LVH) is thickening of the heart muscle of the left ventricle of the heart, that is, left-sided ventricular hypertrophy and resulting increased left ventricular mass. […] The commonly used method to diagnose LVH is echocardiography, with which the thickness of the muscle of the heart can be measured. The electrocardiogram (ECG) often shows signs of increased voltage from the heart in individuals with LVH, so this is often used as a screening test to determine who should undergo further testing. […] Two dimensional echocardiography can produce images of the left ventricle. The thickness of the left ventricle as visualized on echocardiography correlates with its actual mass. Left ventricular mass can be further estimated based on geometric assumptions of ventricular shape using the measured wall thickness and internal diameter.

• #17 Left Ventricular Hypertrophy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557534/

  According to the American Society of Echocardiography and/European Association of Cardiovascular Imaging, LVH is defined as an increased left ventricular mass index (LVMI) to greater than 95 g/m in women and increased LVMI to greater than 115 g/m in men. […] The management of LVH depends on the etiology. Treatment involves lifestyle changes, and depending upon the cause, may include medication, surgery, and an implantable device for the prevention of sudden cardiac death. LVH treatment should be aggressive because patients with LVH are at the highest risk for cardiovascular events and mortality. […] The presence of LVH forecasts an increased risk of cardiovascular morbidity and mortality, even after adjustment for major cardiovascular risk factors such as age, smoking, obesity dyslipidemia, blood pressure, and diabetes. This means that LVH is an independent risk factor for cardiovascular disease. […] Once LVH is developed, it puts the patient at significant risk of developing myocardial ischemia and infarction, heart failure, dysrhythmias, or even sudden death.

• #18 Intern Ultrasound of the Month: Left Ventricular Hypertrophy — University Hospitals Emergency Medicine Residency

  https://www.thelandofem.com/blog/2023/7/4/iusotm-left-ventricular-hypertrophy

  Left ventricular hypertrophy (LVH) is a heart condition that results in an increase in the mass of the LV due an increase in wall thickness and/or enlargement of the LV cavity itself. […] The diagnosis of LVH is largely dependent on echocardiographic measurements or non-invasive imaging techniques. […] According to the American Society of Echocardiography and/European Association of Cardiovascular Imaging, LVH is defined as an increased left ventricular mass index (LVMI) to greater than 95 g/m in women and increased LVMI to greater than 115 g/m in men. […] While not one of the common focused clinical questions answered with POCUS, it is important to recognize LV hypertrophy when present. LVH is defined as LV wall thickness measuring 1.5 cm, which can be easily assessed with POCUS. […] Pay attention to LV wall thickness and recognize hypertrophy when present (1.5cm), especially in patients with concerning clinical findings or historical features.

• #19 Left ventricular hypertrophy detection using electrocardiographic signal | Scientific Reports

  https://www.nature.com/articles/s41598-023-28325-5

  The standard LVH can be obtained from echocardiography by calculating the left ventricle mass index (LVMI) using the Devereux formula. […] The system architecture for detecting LVH is illustrated in Fig. 1. […] Different ECG-based criteria have been proposed for assessing LVH. […] The detection performances of BPN model (accuracy=0.961, precision=0.958, sensitivity=0.966 and specificity=0.956, respectively) are the highest among these 3 models with ECG beat segmentation. […] Detection performances of machine learning models and criteria-based methods performed in this study for assessing Left ventricular hypertrophy are discussed as follows. […] The LVH indirectly implies cardiac overloading and it can be diagnosed by ECG such as the voltage criteria. […] Even by averaging the signals of more ECG cycles for each criteria-based method, the relation between R peak and S valley of each cycle may be changed due to the average process.

• #20 Left ventricular hypertrophy: what lies beneath? – Polish Archives of Internal Medicine

  https://www.mp.pl/paim/issue/article/15118

  The most common pathomechanism of LVH is a long-term increase in afterload, as observed in hypertension or aortic stenosis. […] Another relatively common condition that is always associated with LVH is HCM. […] Hypertrophic cardiomyopathy is characterized by LVH of various degrees, morphologies, and patterns: LV wall thickness exceeding 15 mm in any myocardial segment and asymmetric septal hypertrophy (the ratio of septal to posterior wall thickness 1.3 for normotensive individuals or 1.5 for hypertensive patients) are all considered diagnostic for HCM. […] In approximately 5% to 10% of patients with LVH, who would otherwise be diagnosed with HCM, much rarer causes warrant further investigation. […] The diagnosis requires a multidisciplinary approach as well as the integration of various modalities such as 99mTc-DPD scintigraphy, magnetic resonance imaging, bone marrow or endomyocardial biopsy, and laboratory testing, including genetic studies.

• #21 Left ventricular hypertrophy – Wikipedia

  https://en.wikipedia.org/wiki/Left_ventricular_hypertrophy

  CT and MRI-based measurement can be used to measure the left ventricle in three dimensions and calculate left ventricular mass directly. MRI based measurement is considered the gold standard for left ventricular mass, though is usually not readily available for common practice. […] There are several sets of criteria used to diagnose LVH via electrocardiography. None of them are perfect, though by using multiple criteria sets, the sensitivity and specificity are increased. […] Diagnostic accuracy of electrocardiography in left ventricular hypertrophy can be enhanced with artificial intelligence analysis. […] LVH may be a factor in determining treatment or diagnosis for other conditions, for example, LVH is used in the staging and risk stratification of Non-ischemic cardiomyopathies such as Fabry’s Disease. Patients with LVH may have to participate in more complicated and precise diagnostic procedures, such as echocardiography or cardiac MRI.

• #22 Left ventricular hypertrophy – Wikipedia

  https://en.wikipedia.org/wiki/Left_ventricular_hypertrophy

  CT and MRI-based measurement can be used to measure the left ventricle in three dimensions and calculate left ventricular mass directly. MRI based measurement is considered the gold standard for left ventricular mass, though is usually not readily available for common practice. […] There are several sets of criteria used to diagnose LVH via electrocardiography. None of them are perfect, though by using multiple criteria sets, the sensitivity and specificity are increased. […] Diagnostic accuracy of electrocardiography in left ventricular hypertrophy can be enhanced with artificial intelligence analysis. […] LVH may be a factor in determining treatment or diagnosis for other conditions, for example, LVH is used in the staging and risk stratification of Non-ischemic cardiomyopathies such as Fabry’s Disease. Patients with LVH may have to participate in more complicated and precise diagnostic procedures, such as echocardiography or cardiac MRI.

• #23 Diagnostic Approach and Differential Diagnosis in Patients With Hypertrophied Left Ventricles

  https://www.acc.org/latest-in-cardiology/journal-scans/2014/05/22/18/08/diagnostic-approach-and-differential-diagnosis-in-patients

  Diagnostic Approach and Differential Diagnosis in Patients With Hypertrophied Left Ventricles […] The following are 10 points to remember from a review article on management of left ventricular hypertrophy (LVH) of initially unknown origin: 1. Determination of the underlying etiology of LVH (frequently defined by an LV wall thickness of at least 13 mm) begins with a patients history with emphasis on his/her family history. 2. Transthoracic echocardiography remains the initial screening modality of choice to detect the presence of LVH. 3. As the extremes of LVH seen in athletes (with a presumably physiologic form of LVH) overlap with those seen in patients with morphologically mild hypertrophic cardiomyopathy (HCM), cardiac magnetic resonance (CMR) imaging may be helpful to distinguish these two entities. A cut-off value of 2/ml for diastolic wall-to-volume ratio can differentiate an athletes heart from pathological cardiac hypertrophy. 4. The structural changes of hypertensive heart disease include not only LVH, but also decrease in intramyocardial capillary density and arteriolar wall thickening. 5. In familial HCM, patchy or confluent late-gadolinium enhancement (LGE) on cardiac MRI may be seen, predominantly at the insertion points of the right ventricle into the left ventricle. There is a potential role for LGE as an arbitrator in decision making for primary prevention with implantable cardioverter-defibrillator therapy in patients with HCM. 6. There are three frequently encountered forms of systemic amyloidosis: 1) acquired monoclonal immunoglobulin light chain amyloidosis (AL), 2) hereditary transthyretin (TTR) related form (ATTR), and 3) wild-type TTR, also called senile systemic amyloidosis primarily affecting the hearts of older men. Cardiac disease is rapidly progressive in AL, but disease course is more benign with ATTR or senile systemic amyloidosis. 7. LGE-CMR demonstrates a distinct pattern in amyloidosis with distribution over the entire subendocardial circumference. 8. If there are extracardiac features or a pattern of maternal inheritance, consider mitochondrial myopathy. 9. Anderson-Fabry disease is a lysosomal storage disorder with systemic manifestations (renal failure, corneal deposits, and nervous, gastrointestinal, and cutaneous abnormalities). LGE is found in up to 50% of patients, often in a characteristic pattern affecting the basal and/or apical inferolateral wall. 10. Glycogen storage diseases (or mucopolysaccharidoses) are inherited and rare lysosomal storage disorders characterized by systemic manifestations, LVH, and valve thickening and dysfunction.

• #24 Diagnostic Approach and Differential Diagnosis in Patients With Hypertrophied Left Ventricles

  https://www.acc.org/latest-in-cardiology/journal-scans/2014/05/22/18/08/diagnostic-approach-and-differential-diagnosis-in-patients

  Diagnostic Approach and Differential Diagnosis in Patients With Hypertrophied Left Ventricles […] The following are 10 points to remember from a review article on management of left ventricular hypertrophy (LVH) of initially unknown origin: 1. Determination of the underlying etiology of LVH (frequently defined by an LV wall thickness of at least 13 mm) begins with a patients history with emphasis on his/her family history. 2. Transthoracic echocardiography remains the initial screening modality of choice to detect the presence of LVH. 3. As the extremes of LVH seen in athletes (with a presumably physiologic form of LVH) overlap with those seen in patients with morphologically mild hypertrophic cardiomyopathy (HCM), cardiac magnetic resonance (CMR) imaging may be helpful to distinguish these two entities. A cut-off value of 2/ml for diastolic wall-to-volume ratio can differentiate an athletes heart from pathological cardiac hypertrophy. 4. The structural changes of hypertensive heart disease include not only LVH, but also decrease in intramyocardial capillary density and arteriolar wall thickening. 5. In familial HCM, patchy or confluent late-gadolinium enhancement (LGE) on cardiac MRI may be seen, predominantly at the insertion points of the right ventricle into the left ventricle. There is a potential role for LGE as an arbitrator in decision making for primary prevention with implantable cardioverter-defibrillator therapy in patients with HCM. 6. There are three frequently encountered forms of systemic amyloidosis: 1) acquired monoclonal immunoglobulin light chain amyloidosis (AL), 2) hereditary transthyretin (TTR) related form (ATTR), and 3) wild-type TTR, also called senile systemic amyloidosis primarily affecting the hearts of older men. Cardiac disease is rapidly progressive in AL, but disease course is more benign with ATTR or senile systemic amyloidosis. 7. LGE-CMR demonstrates a distinct pattern in amyloidosis with distribution over the entire subendocardial circumference. 8. If there are extracardiac features or a pattern of maternal inheritance, consider mitochondrial myopathy. 9. Anderson-Fabry disease is a lysosomal storage disorder with systemic manifestations (renal failure, corneal deposits, and nervous, gastrointestinal, and cutaneous abnormalities). LGE is found in up to 50% of patients, often in a characteristic pattern affecting the basal and/or apical inferolateral wall. 10. Glycogen storage diseases (or mucopolysaccharidoses) are inherited and rare lysosomal storage disorders characterized by systemic manifestations, LVH, and valve thickening and dysfunction.

• #25 Left Ventricular Hypertrophy (LVH): Causes, Diagnosis & Treatments | MedStar Health

  https://www.medstarhealth.org/services/left-ventricular-hypertrophy

  Left ventricular hypertrophy (LVH) develops in response to certain medical conditions that can cause the left ventricle (the lower left chamber of the heart responsible for pumping blood to the body) to work harder than normal. […] Diagnosing left ventricular hypertrophy is the first step to developing a treatment plan. Your doctor may recommend one or more diagnostic and imaging procedures. […] An electrocardiogram, also known as an ECG, measures the hearts electrical activity. […] Magnetic resonance imaging, better known as cardiac MRI, is a combination of radio waves, magnets, and computer technology to create images of your heart and blood vessels. […] Stress tests are used to assess how your heart works during physical activity. There are several types of stress tests, including treadmill or bike stress tests, nuclear stress tests, stress echocardiograms, and chemically induced stress tests.

• #26 Left Ventricular Hypertrophy: Causes, Symptoms, Diagnosis, and Treatment – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/left-ventricular-hypertrophy-causes-symptoms-diagnosis-and-treatment

  Left ventricular hypertrophy (LVH) is a condition characterized by the thickening of the muscular wall of the heart’s left ventricle. […] Understanding the causes, recognizing the symptoms, obtaining an accurate diagnosis, and exploring appropriate treatment options are crucial for managing left ventricular hypertrophy. […] To diagnose left ventricular hypertrophy, healthcare providers may use the following methods: […] Electrocardiogram (ECG): This non-invasive test records the electrical activity of the heart and can detect abnormal patterns associated with LVH. […] Echocardiogram: An ultrasound of the heart provides detailed images to assess the thickness of the left ventricular wall and evaluate overall cardiac function. […] Cardiac MRI or CT Scan: These imaging techniques can provide a more comprehensive evaluation of the heart’s structure and function. […] Timely recognition, accurate diagnosis, and appropriate treatment are crucial for managing left ventricular hypertrophy and promoting optimal heart health.

• #27 Differential diagnosis of common etiologies of left ventricular hypertrophy using a hybrid CNN-LSTM model | Scientific Reports

  https://www.nature.com/articles/s41598-022-25467-w

  Differential diagnosis of left ventricular hypertrophy (LVH) is often obscure on echocardiography and requires numerous additional tests. […] The differential diagnosis of unexplained left ventricular hypertrophy (LVH) on echocardiography is important, but challenging. LVH is most commonly a physiologic consequence of increased afterload by hypertension (i.e. hypertensive heart disease [HHD]). However, some patients demonstrate hypertrophied myocardium without an increased afterload; the differential diagnosis in such patients includes hypertrophic cardiomyopathy (HCM) and infiltrative cardiomyopathy, such as light-chain cardiac amyloidosis (ALCA). […] The differential diagnosis of LVH requires a series of expensive, invasive, and time-consuming procedures, such as cardiac magnetic resonance imaging (CMR), endomyocardial biopsy (EMB), and genetic testing.

• #28 Left ventricular hypertrophy: what lies beneath? – Polish Archives of Internal Medicine

  https://www.mp.pl/paim/issue/article/15118

  The most common pathomechanism of LVH is a long-term increase in afterload, as observed in hypertension or aortic stenosis. […] Another relatively common condition that is always associated with LVH is HCM. […] Hypertrophic cardiomyopathy is characterized by LVH of various degrees, morphologies, and patterns: LV wall thickness exceeding 15 mm in any myocardial segment and asymmetric septal hypertrophy (the ratio of septal to posterior wall thickness 1.3 for normotensive individuals or 1.5 for hypertensive patients) are all considered diagnostic for HCM. […] In approximately 5% to 10% of patients with LVH, who would otherwise be diagnosed with HCM, much rarer causes warrant further investigation. […] The diagnosis requires a multidisciplinary approach as well as the integration of various modalities such as 99mTc-DPD scintigraphy, magnetic resonance imaging, bone marrow or endomyocardial biopsy, and laboratory testing, including genetic studies.

• #29 ECG in left ventricular hypertrophy (LVH): criteria and implications – The Cardiovascular

  https://ecgwaves.com/topic/ecg-left-ventricular-hypertrophy-lvh-clinical-characteristics/

  The most common causes of left ventricular hypertrophy are aortic stenosis, aortic regurgitation, hypertension, cardiomyopathy and coarctation of the aorta. There are several ECG indexes, which generally have high diagnostic specificity but low sensitivity. These indexes were developed several decades ago but they are still in use in clinical practice. It should be noted that there are newer, more complicated, indexes that are utilized in modern ECG machines but the sensitivity and specificity are only negligibly better than the old indexes. […] Sokolow-Lyons index is the most used index, despite having the lowest sensitivity (20%) of all indexes. The specificity is high (85%). […] Sensitivity 42%, specificity 95% […] Presumably the best index. Sensitivity 51%, specificity 95%. […] Romhilt-Estes index, which is point-based, has been reported to have a sensitivity of 60%. 4 points make LVH probable. 5 points make LVH very likely.

• #30 Evaluation of the Patient with Incidental Left Ventricular Hypertrophy on Echocardiography – ScienceOpen

  https://www.scienceopen.com/hosted-document?doi=10.15212/CVIA.2019.0011

  A diagnostic algorithm is proposed to help streamline the clinical evaluation of these patients. […] The clinical history is an important adjunct to multimodality imaging in HCM. […] Prompt recognition of the underlying diagnosis has important prognostic and therapeutic implications. Integrating the various, and often subtle, findings on clinical examination and multimodality imaging is essential to distinguishing the different causes, and a methodical approach can help streamline the diagnostic evaluation of these patients.

• #31 Mastering Left Ventricular Hypertrophy: Guide for Nursing Students

  https://simplenursing.com/left-ventricular-hypertrophy/

  Left Ventricular Hypertrophy (LVH) is one of the many conditions associated with cardiomyopathy and heart failure. […] Knowing its treatment, as well as diagnosis, will be crucial in school and after graduation. […] When assessing symptoms of LVH, it’s critical to distinguish between benign LVH and another condition known as “athlete’s heart.” […] However, even before symptoms become apparent, LVH may typically be identified by a simple echocardiography (ECG, or EKG) reading. An electrocardiogram (ECG) measures muscle activity by recording electrical impulses from the heart. […] ECG results will show abnormalities that point to LVH with wave measurements. According to the University of Utah, this is the criteria used to diagnose LVH in an ECG reading:

• #32 Left Ventricular Hypertrophy diagnosis – Training – TrainerRoad

  https://www.trainerroad.com/forum/t/left-ventricular-hypertrophy-diagnosis/86073

  When we hear about left ventricular hypertrophy (LVH), as occurs in pathological conditions such as hypertension (high arterial blood pressure), it is not a good thing. In hypertension the left ventricle has to work harder to eject blood from the heart and pump it through the rest of the body since pressure in the vasculature is higher the heart has to create more pressure (i.e. has to contract more forcefully) to get the blood out during its contraction phase, resulting in concentric (muscle shortening) hypertrophy. Hypertrophy simply means the muscle has gotten bigger. […] Generally, eccentric hypertrophy is not an issue short or long term. This is why cardiologists dont get concerned about LVH seen on an EKG in endurance athletes who are otherwise healthy. The key to the doctor is whether LVH is from eccentric or concentric hypertrophy. An echo can discern this and EKG cannot. In an EKG LVH (more left ventricular tissue both from eccentric as well as concentric hypertrophy) creates a bigger electrical signal when the left ventricle contracts and this electrical signal is what is measured to diagnose LVH from an EKG. […] If they are concerned that something more sinister is at play they will get an echo and/or do further testing to further delineate whether your LVH is of the good (eccentric hypertrophy) or bad (concentric hypertrophy) variety and go from there.

• #33 Diagnostic Approach and Differential Diagnosis in Patients With Hypertrophied Left Ventricles

  https://www.acc.org/latest-in-cardiology/journal-scans/2014/05/22/18/08/diagnostic-approach-and-differential-diagnosis-in-patients

  Diagnostic Approach and Differential Diagnosis in Patients With Hypertrophied Left Ventricles […] The following are 10 points to remember from a review article on management of left ventricular hypertrophy (LVH) of initially unknown origin: 1. Determination of the underlying etiology of LVH (frequently defined by an LV wall thickness of at least 13 mm) begins with a patients history with emphasis on his/her family history. 2. Transthoracic echocardiography remains the initial screening modality of choice to detect the presence of LVH. 3. As the extremes of LVH seen in athletes (with a presumably physiologic form of LVH) overlap with those seen in patients with morphologically mild hypertrophic cardiomyopathy (HCM), cardiac magnetic resonance (CMR) imaging may be helpful to distinguish these two entities. A cut-off value of 2/ml for diastolic wall-to-volume ratio can differentiate an athletes heart from pathological cardiac hypertrophy. 4. The structural changes of hypertensive heart disease include not only LVH, but also decrease in intramyocardial capillary density and arteriolar wall thickening. 5. In familial HCM, patchy or confluent late-gadolinium enhancement (LGE) on cardiac MRI may be seen, predominantly at the insertion points of the right ventricle into the left ventricle. There is a potential role for LGE as an arbitrator in decision making for primary prevention with implantable cardioverter-defibrillator therapy in patients with HCM. 6. There are three frequently encountered forms of systemic amyloidosis: 1) acquired monoclonal immunoglobulin light chain amyloidosis (AL), 2) hereditary transthyretin (TTR) related form (ATTR), and 3) wild-type TTR, also called senile systemic amyloidosis primarily affecting the hearts of older men. Cardiac disease is rapidly progressive in AL, but disease course is more benign with ATTR or senile systemic amyloidosis. 7. LGE-CMR demonstrates a distinct pattern in amyloidosis with distribution over the entire subendocardial circumference. 8. If there are extracardiac features or a pattern of maternal inheritance, consider mitochondrial myopathy. 9. Anderson-Fabry disease is a lysosomal storage disorder with systemic manifestations (renal failure, corneal deposits, and nervous, gastrointestinal, and cutaneous abnormalities). LGE is found in up to 50% of patients, often in a characteristic pattern affecting the basal and/or apical inferolateral wall. 10. Glycogen storage diseases (or mucopolysaccharidoses) are inherited and rare lysosomal storage disorders characterized by systemic manifestations, LVH, and valve thickening and dysfunction.

• #34 Left Ventricular Hypertrophy: Pathology Versus Physiology | SpringerLink

  https://link.springer.com/chapter/10.1007/978-94-011-4279-3_6

  Because of the increased risk for adverse cardiac events it is important to differentiate between physiologic (exercise-induced) and pathologic (disease-induced) left ventricular hypertrophy. […] Pathologic left ventricular hypertrophy is the result of maladaptation of the heart to overload and is a strong risk factor for cardiovascular morbidity and sudden death. […] The main focus of this chapter is hypertension-induced left ventricular hypertrophy. Hypertension is the most common cause of left ventricular hypertrophy in the general population, which is associated with diastolic function abnormalities and an increased incidence of ventricular arrhythmias. […] Regression of left ventricular hypertrophy by antihypertensive drugs [e.g. angiotensin converting enzyme (ACE)-inhibitors] has been associated with lower cardiac mortality and improved prognosis of cardiovascular events. […] In addition to morphological changes, other criteria such as diastolic function, proneness to rhythm disturbances, family history and the electrocardiogram can be used to classify an enlarged heart as either a physiological or a pathological phenomenon.

• #35 Left Ventricular Hypertrophy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557534/

  According to the American Society of Echocardiography and/European Association of Cardiovascular Imaging, LVH is defined as an increased left ventricular mass index (LVMI) to greater than 95 g/m in women and increased LVMI to greater than 115 g/m in men. […] The management of LVH depends on the etiology. Treatment involves lifestyle changes, and depending upon the cause, may include medication, surgery, and an implantable device for the prevention of sudden cardiac death. LVH treatment should be aggressive because patients with LVH are at the highest risk for cardiovascular events and mortality. […] The presence of LVH forecasts an increased risk of cardiovascular morbidity and mortality, even after adjustment for major cardiovascular risk factors such as age, smoking, obesity dyslipidemia, blood pressure, and diabetes. This means that LVH is an independent risk factor for cardiovascular disease. […] Once LVH is developed, it puts the patient at significant risk of developing myocardial ischemia and infarction, heart failure, dysrhythmias, or even sudden death.

• #36 Left Ventricular Hypertrophy (LVH)

  https://my.clevelandclinic.org/health/diseases/21883-left-ventricular-hypertrophy

  Treating the cause of LVH will help stop or slow disease progression. Depending on the cause, you may need to change your daily habits, take medicine or have surgery. […] Left untreated, LVH (and related underlying heart conditions) increases your risk of serious heart disease or even death. Treatment to slow or stop the progression of left ventricular hypertrophy lowers the risk of severe heart damage. An early and accurate diagnosis is the key to improving the outlook for people with left ventricular hypertrophy. […] If you have a heart condition that could lead to LVH, catching and treating it early can make a big difference. Treatment can help prevent left ventricular hypertrophy from developing. It can also reduce the risk of damage to your heart muscle.

• #37 Electrocardiographic Diagnosis of Left Ventricular Hypertrophy – ABC Cardiol

  https://abccardiol.org/en/short-editorial/electrocardiographic-diagnosis-of-left-ventricular-hypertrophy/

  Left Ventricular Hypertrophy (LVH) is defined as an increase in left ventricular (LV) mass, which may be secondary to an increase in wall thickness (concentric LVH), increased cavity size (eccentric LVH), or both. The presentation of hypertrophied LV depends mainly on the underlying disease, with concentric LVH resulting in most cases from LV pressure overload (hypertension or aortic stenosis), while eccentric LVH mainly depends on LV volume overloads (mitral and aortic insufficiency) and dilated cardiomyopathies. Other causes of LVH include ventricular septal defects, hypertrophic cardiomyopathy, and physiological changes associated with athletic training. […] The presence of LVH is clinically meaningful because it is associated with an increased incidence of heart failure, ventricular arrhythmias, peripheral vascular insufficiency, aortic dilatation, cerebrovascular events and sudden death or after myocardial infarction.

• #38 Changing the diagnostic paradigm of the ECG diagnosis of left ventricular hypertrophy

  http://www.hvt-journal.com/articles/art429

  Left ventricular hypertrophy is not a simple increase in left ventricular mass, but it is a complex rebuilding of the left ventricle at organ, tissue cellular, subcellular and molecular levels. […] Summarizing, the ECG / QRS patterns associated with LVH are markers of altered electrical properties of hypertrophied myocardium we need to understand better. The new paradigm of ECG diagnostic of LVH opens thus an exciting area for clinical and basic research.

• #39 The Role of ECG in the Diagnosis of Left Ventricular Hypertrophy

  https://eurekaselect.com/public/article/60487

  The traditional approach to the ECG diagnosis of left ventricular hypertrophy (LVH) is focused on the best estimation of left ventricular mass (LVM) i.e. finding ECG criteria that agree with LVM as detected by imaging. However, it has been consistently reported that the magnitude of agreement is rather low as reflected in the low sensitivity of ECG criteria. As a result, the majority of cases with true anatomical LVH could be misclassified by using ECG criteria of LVH. […] Despite this limitation, it has been reported that the ECG criteria for LVH provide independent information on the cardiovascular risk even after adjusting for LVM. Understanding possible reasons for the frequent discrepancy between common ECG LVH criteria and LVH by echo or MRI would help understanding the genesis of ECG changes that occur as a consequence of increased LV mass.

• #40 Changing the diagnostic paradigm of the ECG diagnosis of left ventricular hypertrophy

  http://www.hvt-journal.com/articles/art429

  Left ventricular hypertrophy is not a simple increase in left ventricular mass, but it is a complex rebuilding of the left ventricle at organ, tissue cellular, subcellular and molecular levels. […] Summarizing, the ECG / QRS patterns associated with LVH are markers of altered electrical properties of hypertrophied myocardium we need to understand better. The new paradigm of ECG diagnostic of LVH opens thus an exciting area for clinical and basic research.

• #41 Left ventricular hypertrophy detection using electrocardiographic signal | Scientific Reports

  https://www.nature.com/articles/s41598-023-28325-5

  Left ventricular hypertrophy (LVH) indicates subclinical organ damage, associating with the incidence of cardiovascular diseases. […] Nowadays, there are many criteria for assessing LVH by ECG. […] The diagnosis of LVH by ECG is made according to various criteria, such as Cornell and SokolowLyon criteria, which check the summations of voltage amplitudes of S and R waves representing the left ventricle depolarization. […] Detecting LVH using ECG is time efficient and reproducible. […] Although ECG-based new criteria or new studies using existing criteria for detecting LVH have been proposed or reported in recent years, the overall sensitivity and precision are still disappointing. […] Therefore, this study aims to develop a system for identifying LVH using our suggested ECG signal processing method and machine learning model to improve the LVH detection performances using ECG.

• #42 Left ventricular hypertrophy – Wikipedia

  https://en.wikipedia.org/wiki/Left_ventricular_hypertrophy

  CT and MRI-based measurement can be used to measure the left ventricle in three dimensions and calculate left ventricular mass directly. MRI based measurement is considered the gold standard for left ventricular mass, though is usually not readily available for common practice. […] There are several sets of criteria used to diagnose LVH via electrocardiography. None of them are perfect, though by using multiple criteria sets, the sensitivity and specificity are increased. […] Diagnostic accuracy of electrocardiography in left ventricular hypertrophy can be enhanced with artificial intelligence analysis. […] LVH may be a factor in determining treatment or diagnosis for other conditions, for example, LVH is used in the staging and risk stratification of Non-ischemic cardiomyopathies such as Fabry’s Disease. Patients with LVH may have to participate in more complicated and precise diagnostic procedures, such as echocardiography or cardiac MRI.

• #43 CoAt-Mixer: Self-attention deep learning framework for left ventricular hypertrophy using electrocardiography | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0286916

  Left ventricular hypertrophy is a significant independent risk factor for all-cause mortality and morbidity, and an accurate diagnosis at an early stage of heart change is clinically significant. […] Electrocardiography is the most convenient, economical, and non-invasive method for screening in primary care. However, the coincidence rate of the actual left ventricular hypertrophy and diagnostic findings was low, consequently increasing the interest in algorithms using big data and deep learning. […] We attempted to diagnose left ventricular hypertrophy using big data and deep learning algorithms, and aimed to confirm its diagnostic power according to the differences between males and females. […] Our model confirmed that left ventricular hypertrophy can be classified to some extent using electrocardiography, demographics, and electrocardiography features. In particular, a learning environment that considered gender differences was constructed. Consequently, the difference in diagnostic power between men and women was confirmed.

• #44 Evaluation of the Patient with Incidental Left Ventricular Hypertrophy on Echocardiography – ScienceOpen

  https://www.scienceopen.com/hosted-document?doi=10.15212/CVIA.2019.0011

  A diagnostic algorithm is proposed to help streamline the clinical evaluation of these patients. […] The clinical history is an important adjunct to multimodality imaging in HCM. […] Prompt recognition of the underlying diagnosis has important prognostic and therapeutic implications. Integrating the various, and often subtle, findings on clinical examination and multimodality imaging is essential to distinguishing the different causes, and a methodical approach can help streamline the diagnostic evaluation of these patients.

• #45 Left Ventricular Hypertrophy Symptoms/Causes – Orange County

  https://www.hoag.org/specialties-services/heart-vascular/specialty-programs/heart-failure-program/conditions/left-ventricular-hypertrophy/

  Prevention of these complications typically requires an accurate diagnosis of left ventricular hypertrophy. […] If you are diagnosed with a condition that can possibly lead to left ventricular hypertrophy, it is important to schedule regular checkups with your healthcare provider to monitor and maintain your heart health. […] During these checkups, a doctor may even diagnose left ventricular hypertrophy before it can become more severe.

• #46 Left ventricular hypertrophy: what lies beneath? – Polish Archives of Internal Medicine

  https://www.mp.pl/paim/issue/article/15118

  The most common pathomechanism of LVH is a long-term increase in afterload, as observed in hypertension or aortic stenosis. […] Another relatively common condition that is always associated with LVH is HCM. […] Hypertrophic cardiomyopathy is characterized by LVH of various degrees, morphologies, and patterns: LV wall thickness exceeding 15 mm in any myocardial segment and asymmetric septal hypertrophy (the ratio of septal to posterior wall thickness 1.3 for normotensive individuals or 1.5 for hypertensive patients) are all considered diagnostic for HCM. […] In approximately 5% to 10% of patients with LVH, who would otherwise be diagnosed with HCM, much rarer causes warrant further investigation. […] The diagnosis requires a multidisciplinary approach as well as the integration of various modalities such as 99mTc-DPD scintigraphy, magnetic resonance imaging, bone marrow or endomyocardial biopsy, and laboratory testing, including genetic studies.

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