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Chapter 6: Left Ventricular Hypertrophy

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Chapter 6: Left Ventricular Hypertrophy

The left ventricle is the part of the heart most affected by heart disease. At least 20% of adults over the age of 50 have left ventricular hypertrophy (LVH), defined as an increase in the mass of the left ventricle. It can be due to an increase in its wall thickness or cavity size, or both. The most common causes of LVH are hypertension and aortic stenosis.

LVH is an independent predictor of premature death. This finding is attributed to resultant malignant ventricular arrhythmia and heart failure. Angiotensin-converting enzyme (ACE) inhibitors may reduce and prevent LVH and are used to prevent its fatal consequences. 

Early diagnosis of LVH is invaluable. 12-lead ECG is an important but imperfect tool for the diagnosis, but the condition is best diagnosed using imaging studies such as echocardiography or magnetic resonance imaging.

Echocardiography is able to quantify left ventricular mass and assist the clinician in grading the severity of LVH:2

  • Mildly abnormal left ventricular mass 
    • male: 201–227 grams
    • female: 151–171 grams
  • Moderately abnormal left ventricular mass 
    • male: 228–254 grams
    • female: 172–193 grams 
  • Severely abnormal left ventricular mass 
    • male: > 254 grams 
    • female: > 193 grams


2 Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–271.

https://academic.oup.com/ehjcimaging/article/16/3/233/2400086