Functional Evaluation of the Hypertrophied Heart in Man

A method for determining left ventricular wall thickness and mass from angiocardiograms is reviewed, together with a description of normal values. The relationships of left ventricular mass to increased left ventricular pressure and volume work loads, and to diastolic volume changes, as occur with valvular heart disease and also with myocardial disease, are described. The shapes of the normal left ventricle, the dilated hypertrophied left ventricle resulting from volume overload, and ventricles with depressed myocardial performance are described and compared. The more spherical ventricles observed in association with depressed myocardial performance have altered distribution of systolic wall forces. The displacement of blood due to wall thickening is computed and represents nearly 50% of the stroke volume in normal man and nearly 60% in a subject with left ventricular hypertrophy secondary to aortic valve stenosis. Preoperative and postoperative studies in 22 subjects demonstrate that when left ventricular hypertrophy is very advanced, it is rarely, if ever, completely reversible following aortic and/or mitral valve replacement for valvular heart disease.