Left ventricular hypertrophy (LVH) is an important adaptive response to pressure or volume overload of the left ventricle. The presence of LVH is most accurately detected by echocardiography or cardiac angiography [l, 2], and has important implications with regard to the prognosis of the underlying heart disease. Left ventricular hypertrophy is initially a physiological adaptive response, but with time this physiological response becomes pathological, and may be associated with impaired contractility and irreversible myocardial dysfunction. The point at which this transition from physiological to pathological hypertrophy occurs is unknown. Regression of LVH has been shown to occur in animals and humans. The evidence for left ventricular regression and the significance of this regression and its relationship to myocardial function, as well as the prognostic implications, form the basis of this chapter.

Regression of Left Ventricular Hypertrophy: Clinical Considerations

The serial application of electrocardiography and echocardiography to 67 selected patients undergoing valve replacement for chronic severe aortic regurgitation, documented regression of hypertrophy and chamber size within six to twelve months of surgery in all cases experiencing haemodynamic improvement. Those patients who had persistently increased patterns of myocardial hypertrophy and abnormal end-diastolic dimensions in the presence of normal prosthetic (homograft) function usually had persistent, irreversibly depressed myocardial function postoperatively. Preoperative noninvasive and angiographic characteristics could not predict ventricular function after surgery. Thus we could not precisely define what level of depressed ventricular performance or what degree of dilatation and myocardial hypertrophy constituted an irreversible state from this data. Although operative factors such as myocardial protection during cardiopulmonary bypass may influence postoperative cardiac performance, preoperative histological and histochemical data was useful in delineating irreversible morphological and function changes contributing to a depressed cardiac function, and therefore may be of prognostic importance.

Left ventricular mass, volume and biopsy analysis in prediction of ventricular function after surgery for chronic aortic regurgitation.

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Left ventricular mass, volume and biopsy analysis in prediction of ventricular function after surgery for chronic aortic regurgitation.