Home › Pathology guides › Concentric LV hypertrophy

Concentric LV hypertrophy on echocardiography

Uniformly thick walls (above about 10 mm in men and 9 mm in women; concentric when relative wall thickness exceeds 0.42), a normal or small cavity and normal or vigorous radial function. LVH itself is defined by LV mass index.

Watch it in the simulator →Practise random cases

Where to look

PLAX for end-diastolic septal and inferolateral wall thickness (and relative wall thickness), PSAX for concentric distribution.

Typical wall-motion pattern

Example: Concentric LVH

All 17 segments thicken normally.

EF in this example: 66% (Normal (≥55%)).

1 Normal2 Hypokinetic3 Akinetic4 Dyskinetic5 Aneurysmal

Ejection fraction

Across 24 simulated cases of this pattern the true EF ranged from 65% to 70% (median 69%, Normal (≥55%)). Every case in the simulator is different, so practise until your visual estimate lands in the right 5% range.

Teaching points

Concentric LVH: uniformly thick walls, small cavity, normal (often vigorous) systolic function. EF can look high; the RWMA score is normal.
Ventricular ectopics: the premature beat is weak and dyssynchronous and the beat after the pause is stronger. Judge EF and wall motion on normal sinus beats only.
Atrial fibrillation: filling and EF vary from beat to beat. Average at least five beats, or use an index beat (one that follows two similar RR intervals), and avoid beats after a very short RR interval.

Common pitfalls

A small cavity can look hyperdynamic; EF may overstate systolic function.

Try it now: open the Concentric LV hypertrophy example with the segment overlay, then test yourself in Practice where cases are random and graded against the exact answer.