Left ventricular hypertrophy regression as a process with variable biological implications

Abstract

Objective: To determine whether myocardial hypertrophy regression, similarly to hypertrophy itself, is a process of variable nature with different biological implications.

Data sources: Current Contents and MEDLINE searches under myocardial hypertrophy and regression of hypertrophy-related headings were conducted.

Data extraction: The search covered the period from 1969 to 1994, and 89 articles dealing with both human and animal studies were used.

Data synthesis: The positive adaptive effect of left ventricular myocardial hypertrophy may be counterbalanced by increased incidence of heart failure, myocardial infarction or sudden death. The risk of undesirable cardiovascular events varies according to the character of hypertrophic growth. Reduction of cardiac mass to that of a normal heart need not always mean that the ventricle is normal in all aspects. Several forms of left ventricular hypertrophy regression may be distinguished. The hypertrophy regression of the athletic heart is of a physiological nature. The spontaneous regression of left ventricular hypertrophy as seen in the rabbit model of aortic insufficiency has a pathological aspect resulting in heart failure. The nature of therapeutically induced regression of hypertrophy may vary according to fibrotic tissue concentration, energetical state and the function of the regressed heart.

Conclusion: The biological implication of hypertrophy regression varies especially with respect to the nature of hypertrophy and the mode of achievement of hypertrophied mass reversal. Only long term prospective studies can clarify the question as to which types of hypertrophy regression result in decreased cardiovascular risk.