Understanding LVH: Concentric versus eccentric hypertrophy

When we talk about left ventricular hypertrophy (LVH) in cardiac imaging, the terms concentric LVH and eccentric LVH are often used. However the word 'eccentric' sometimes causes confusion - it's important to realise that the word 'eccentric' does not mean 'asymmetric' in the context of LVH. So what is eccentric LVH, and how does it differ from concentric LVH?

Cardiac MRI showing severe concentric LVH

Concentric LVH is seen in situations where there is pressure overload of the left ventricle. Examples include hypertension and aortic stenosis. The heart adapts to pressure overload by adding new sarcomeres in parallel to existing sarcomeres. This leads to an increase in left ventricular wall thickness and left ventricular mass, but the cavity size remains normal.

Eccentric LVH, in contrast, occurs when there is volume overload of the left ventricle. This is seen with valvular regurgitation (aortic or mitral), or can occur as a result of cardiac remodelling in endurance athletes. In this situation, the heart adapts to volume overload by adding new sarcomeres in series with existing sarcomeres. The end result is an increase in left ventricular cavity size and an increase in left ventricular mass, but the wall thickness remains normal.

Concentric versus eccentric LVH

If you'd like to read more on this topic, check out these links:

Mihl C, et al. Cardiac remodelling: concentric versus eccentric hypertrophy in strength and endurance athletes. Neth Heart J 2008; 16: 129–133.

Marwick TH, et al. Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). European Heart Journal – Cardiovascular Imaging 2015; 16: 577-605.