Barbieri Andrea, Albini Alessandro, Maisano Anna, De Mitri Gerardo, Camaioni Giovanni, Bonini Niccolò, Mantovani Francesca, Boriani Giuseppe
Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Cardiology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Front Cardiovasc Med. 2021 Apr 27;8:667984. doi: 10.3389/fcvm.2021.667984. eCollection 2021.
Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.
超声心动图是评估左心室肥厚（LVH）最有效的非侵入性方法且应用广泛。其他方法，特别是磁共振成像，在大规模临床应用中成本高昂且存在实际挑战。为涵盖广泛的生理和病理状况，LVH应结合左心室重构评估进行考虑。普遍认可的LVH两组分类仅将左心室质量和相对壁厚度（RWT）的估计视为分类变量。然而，两组模式的知识在LVH之外提供的增量预后信息特别有限。相反，左心室扩大对于新发心力衰竭而言，在左心室质量之外还具有独立的预后价值。因此，最近有人提出基于左心室质量、左心室容积和RWT的LVH四分法。这种新颖的LVH分类的特点是心功能存在明显差异，使临床医生能够区分各种心血管疾病中不同的左心室血流动力学应激适应情况。新的LVH四分法具有优化LVH诊断方法的优势，并有可能改善对需要靶向治疗的适应不良反应的识别。在本综述中，我们总结了目前关于LVH分类细化的临床价值的知识，强调了超声心动图在应用当代提出的指数化方法和划分值方面的作用。
