Refining the classification of left ventricular hypertrophy to provide new insights into the progression from hypertension to heart failure

Purpose of review: Left ventricular hypertrophy (LVH), an important consequence of hypertension, is traditionally classified as either concentric or eccentric based on the presence or absence of increased relative wall thickness. In 2010, we proposed a novel four-tiered classification that accounted for LV dilatation in addition to LV wall thickness. The purpose of this review is to discuss the rationale for this revised classification and highlight subsequent studies that have assessed its utility. Recent findings: A series of recent observational studies have tested whether the four-tiered classification identifies subphenotypes of LVH with differential risk of adverse outcomes, including incident heart failure. The majority have confirmed that eccentric hypertrophy can be subdivided into a high-risk and a low-risk group based on whether LV dilatation is present. Additional studies have shown that LV dilatation is an independent risk factor for the development of heart failure. Summary: Incorporation of LV dilatation into the assessment of LVH identifies important subphenotypes within the standard two-tiered classification that have differential risk. Such refinements in the classification of LVH may yield new insights into how LVH progresses to heart failure, help identify risk factors for this transition, and improve therapeutic efforts to prevent its occurrence.