Differenzialdiagnose der linksventrikulären Hypertrophie

Von einer linksventrikulären Hypertrophie (LVH) spricht man, wenn die Muskelmasse des linken Ventrikels vergrößert ist. Diese Veränderung tritt bei verschiedenen Ursachen auf, die zu einer Druck- oder Volumenbelastung des linken Ventrikels führen. Zudem gehen auch (infiltrative) Kardiomyopathien mit einer linksventrikulären Wandverdickung einher. Die häufigsten Ursachen einer LVH werden im Folgenden behandelt.

Kernaussagen

• Eine linksventrikuläre Hypertrophie (LVH) kommt am häufigsten bei einer Hypertonie vor.

• Ein EKG kann Hinweise auf eine LVH liefern, hat aber eine geringe Sensitivität.

• Bildgebende Verfahren wie Echokardiografie und MRT sind die wesentlichen diagnostischen Verfahren in der Abklärung und Differenzierung der Ursachen.

• Die Wanddicke kann und sollte mit jeder Bildgebung des Herzens bestimmt werden. Allerdings sind die absoluten Messwerte der verschiedenen Verfahren nicht übertragbar.

Schlüsselwörter

linksventrikuläre Hypertrophie - hypertrophe Kardiomyopathie - Sportlerherz - Amyloidose

Keywords

left ventricular hypertrophy - hypertrophic cardiomyopathy - athletic heart syndrome - amyloidosis

Publication History

Article published online:
06 December 2024

• Literatur

• 1 Moura B, Aimo A, Al-Mohammad A. et al. Diagnosis and management of patients with left ventricular hypertrophy: Role of multimodality cardiac imaging. A scientific statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2023; 25: 1493-1506
• 2 Elliott PM, Anastasakis A, Borger MA. Authors/Task Force members. et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2733-2779
• 3 Bornstein AB, Rao SS, Marwaha K. Left Ventricular Hypertrophy. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2023
• 4 Lazzeroni D, Rimoldi O, Camici PG. From Left Ventricular Hypertrophy to Dysfunction and Failure. Circ J 2016; 80: 555-564
• 5 Sayin BY, Oto A. Left Ventricular Hypertrophy: Etiology-Based Therapeutic Options. Cardiol Ther 2022; 11: 203-230
• 6 Cuspidi C, Sala C, Negri F. et al. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens 2012; 26: 343-349
• 7 Hancock EW, Deal BJ, Mirvis DM. et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009; 53: 992-1002
• 8 Eber M, Lichtenauer M. Die Linksherzhypertrophie im EKG. Accessed July 16, 2024 at: https://www.universimed.com/de/article/kardiologie-gefaessmedizin/die-linksherzhypertrophie-im-ekg-2099644
• 9 Bacharova L, Estes EH. Left Ventricular Hypertrophy by the Surface ECG. J Electrocardiol 2017; 50: 906-908
• 10 Marwick TH, Gillebert TC, Aurigemma G. 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)†. Eur Heart J Cardiovasc Imaging 2015; 16: 577-605
• 11 Lang RM, Bierig M, Devereux RB. et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440-1463
• 12 Muraru D, Cucchini U, Mihaila S. et al. Left ventricular myocardial strain by three-dimensional speckle-tracking echocardiography in healthy subjects: reference values and analysis of their physiologic and technical determinants. J Am Soc Echocardiogr 2014; 27: 858-871.e1
• 13 Mizukoshi K, Takeuchi M, Nagata Y. et al. Normal Values of Left Ventricular Mass Index Assessed by Transthoracic Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2016; 29: 51-61
• 14 Dichtl W. Echokardiographie in der Abklärung der arteriellen Hypertonie. J Hyperton 2016; 20: 94-97
• 15 Barbieri A, Bursi F, Mantovani F. et al. Left ventricular hypertrophy reclassification and death: application of the Recommendation of the American Society of Echocardiography/European Association of Echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13: 109-117
• 16 Walpot J, Juneau D, Massalha S. et al. Left Ventricular Mid-Diastolic Wall Thickness: Normal Values for Coronary CT Angiography. Radiol Cardiothorac Imaging 2019; 1: e190034
• 17 Kara B, Nayman A, Guler I. et al. Quantitative Assessment of Left Ventricular Function and Myocardial Mass: A Comparison of Coronary CT Angiography with Cardiac MRI and Echocardiography. Pol J Radiol 2016; 81: 95-102
• 18 Grajewski KG, Stojanovska J, Ibrahim EH. et al. Left Ventricular Hypertrophy: Evaluation With Cardiac MRI. Curr Probl Diagn Radiol 2020; 49: 460-475
• 19 Burrage MK, Ferreira VM. Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy. Curr Heart Fail Rep 2020; 17: 192-204
• 20 Alkema M, Spitzer E, Soliman OI. et al. Multimodality Imaging for Left Ventricular Hypertrophy Severity Grading: A Methodological Review. J Cardiovasc Ultrasound 2016; 24: 257-267
• 21 Nemtsova V, Burkard T, Vischer AS. Hypertensive Heart Disease: A Narrative Review Series-Part 2: Macrostructural and Functional Abnormalities. J Clin Med 2023; 12
• 22 Barbieri A, Albini A, Maisano A. et al. Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification. Front Cardiovasc Med 2021; 8: 667984
• 23 Tanaka H. Efficacy of echocardiography for differential diagnosis of left ventricular hypertrophy: special focus on speckle-tracking longitudinal strain. J Echocardiogr 2021; 19: 71-79
• 24 Chambers J. The left ventricle in aortic stenosis: evidence for the use of ACE inhibitors. Heart 2006; 92: 420-423
• 25 Rader F, Sachdev E, Arsanjani R. et al. Left ventricular hypertrophy in valvular aortic stenosis: mechanisms and clinical implications. Am J Med 2015; 128: 344-352
• 26 Lovic D, Narayan P, Pittaras A. et al. Left ventricular hypertrophy in athletes and hypertensive patients. J Clin Hypertens (Greenwich) 2017; 19: 413-417
• 27 Junho CVC, Frisch J, Soppert J. et al. Cardiomyopathy in chronic kidney disease: clinical features, biomarkers and the contribution of murine models in understanding pathophysiology. Clin Kidney J 2023; 16: 1786-1803
• 28 Slany J. Kardiorenale Syndrome. J Hyperton 2011; 15: 20-23
• 29 Arbelo E, Protonotarios A, Gimeno JR. et al. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44: 3503-3626
• 30 Lousada I, Comenzo RL, Landau H. et al. Light Chain Amyloidosis: Patient Experience Survey from the Amyloidosis Research Consortium. Adv Ther 2015; 32: 920-928
• 31 Yilmaz A, Bauersachs J, Kindermann I. et al. Diagnostik und Therapie der kardialen Amyloidose. Kardiologe 2019; 13: 264-291
• 32 Linhart A, Kampmann C, Zamorano JL. et al. Cardiac manifestations of Anderson-Fabry disease: results from the international Fabry outcome survey. Eur Heart J 2007; 28: 1228-1235
• 33 Hoffmann B, Mayatepek E. Fabry disease-often seen, rarely diagnosed. Dtsch Arztebl Int 2009; 106: 440-447
• 34 Thompson RB, Chow K, Khan A. et al. T₁mapping with cardiovascular MRI is highly sensitive for Fabry disease independent of hypertrophy and sex. Circ Cardiovasc Imaging 2013; 6: 637-645