Concentric hypertrophy

Concentric hypertrophy is a hypertrophy of the heart wall in the direction of the cavum caused by significant hemodynamic obstruction (Kasper 2015).

As a result of the chronic cardiac pressure load, the ventricular lumen initially remains the same but then becomes smaller (Krause 2022).

A distinction is made between left ventricular and right ventricular concentric cardiac hypertrophy (Wettstein 2001).

From a septal thickness > 12 mm, this is referred to as cardiac hypertrophy (Flachskampf 2011).

The pressure hypertrophy of the left ventricle initially results in concentric hypertrophy. In the late stage, however, left ventricular dilatation develops, known as eccentric hypertrophy (Mewis 2006).

This transformation from concentric to eccentric hypertrophy occurs from a critical heart weight of 500 g (Herold 2025). Eccentric hypertrophy restricts the contractility of the heart (Mewis 2006).

• Concentric left ventricular hypertrophyis found in e.g.:
  • Aortic valve stenosis
  • aortic valve insufficiency
  • Aortic isthmus stenosis
  • Arterial hypertension (up to the critical heart weight of 500 g)
  • Chronic kidney disease (Herold 2025)
  • Cardiac amyloidosis (Möbius-Winkler 2024)
  • Pulmonary valve stenosis
  • Pronounced bradycardia with increased stroke volume
  • Pulmonary hypertension due to e.g. pulmonary embolism or mitral valve disease
  • Hyperthyroidism
  • Large left-right shunt (Lohr 2002)
  • Fabry disease (Weidemann 2015)

• In the case of concentric left ventricular hypertrophy in infants or children, the following diseases should be excluded:
  • Glycogen storage disease (GSD) with concentric LVH, but also extreme LVD, hypoglycemia, elevation of AST/ALT, global hypokinesia,
  • Friedreich's ataxia with concentric LVH, global hypokinesia, ataxia, muscle weakness
  • Danon storage disease with extreme LVH, learning difficulties, mental retardation
  • Mitochondrial with concentric LVH, global hypokinesia, metabolic acidosis, encephalopathy, muscle weakness, learning difficulties up to intellectual disability, deafness (Arbelo, Guidelines 2023)

• Concentric right ventricular hypertrophy can be caused by:
  • Eisenmenger syndrome (Herold 2025)
  • Pulmonary valve stenosis (Christ 2019)

Concentric hypertrophy of the heart occurs due to increased pressure work. This sustained increase in pressure eventually causes the wall of the muscles to thicken more and more in the direction of the cavum, resulting in a narrowing of the outflow tract (Lohr 2002). The systolic wall tension increases as a result (Krams 2010) and cardiac function improves (Oldfield 2020). This is also referred to as physiological cardiac hypertrophy (Nakamura 2018).

Typical of concentric hypertrophy is the increase in the wall thickness of the heart chambers at the expense of the clearing. The trabeculae are also often thickened and protruding. The inner ventricular configuration towards the apex of the heart increasingly resembles a Gothic pointed arch (Bankl 1999).

However, cardiac index and ejection fraction are usually normal (Lohr 2002).

However, an imbalance between oxygen supply and oxygen consumption occurs as hypertrophy progresses (Claus 2019).

From a critical heart weight of 500 g, concentric hypertrophy turns into eccentric hypertrophy (Herold 2025). This eccentric hypertrophy restricts the contractility of the heart (Mewis 2006).

ECG

- Left ventricular hypertrophy

Chronic left ventricular strain results in a left ventricular hypertrophy type, left ventricular hypertrophy signs with a positive Sokolow-Lyon index and excitation regression disturbances in the left precordial leads (Wettstein 2001).

- Right ventricular hypertrophy

Chronic right ventricular hypertrophy can be characterized by a right ventricular hypertrophy, P-dextroatrial, positive Sokolow-Lyon index and right bundle branch block (Wettstein 2001).

Echocardiogram

Significant increase in the weight of the heart due to thickening of the left ventricular muscle mass up to 20 mm and a narrowing of the cavity (Kirchner 2010). In addition, the (restricted) ejection fraction and any existing diastolic dysfunction can also be detected during the examination (Siegenthaler 2002).

Computer tomography

The thickening of the heart wall can be visualized particularly well in a CT scan (Kirchner 2010).

Chest X-ray

Concentric hypertrophy cannot be shown on an X-ray, as the muscle thickness cannot be assessed radiologically (Hamer 2013).

Only when concentric hypertrophy becomes eccentric hypertrophy due to volume loading is it radiologically detectable at an early stage (Herold 2025).

• Athlete's heart (Möbius-Winkler 2024)

Concentric hypertrophy can lead to:

• Eccentric hypertrophy (Mewis 2006)
• Myocardial ischemia
• Myocardial infarctions
• Heart failure (Claus 2019)
• Acute pulmonary edema (Siegenthaler 2002)

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