What is a Hyperdynamic Left Ventricle?
A hyperdynamic left ventricle is a condition where the left ventricle has a higher-than-normal ejection fraction. The ejection fraction is the percentage of the blood that leaves the left ventricle with every heartbeat.
One might think that a hyperdynamic left ventricle is beneficial since it means that the heart is pumping more blood. However, studies indicate that this is not the case. [1]
Patients with hyperdynamic left ventricles have a higher prevalence of diastolic dysfunction. This is a condition in which the filling of the heart is impaired [1]. Diastolic dysfunction can reduce the life expectancy of patients and is associated with: [1].
- aortic stenosis, often linked to left ventricular hypertrophy [2],
- heart failure: around 50% of heart failure patients have diastolic dysfunction [3],
- coronary artery disease and left ventricular hypertrophy [4],
- hypertension and diabetes, particularly in elderly individuals [5],
- cardiac fibrosis [6].
Hyperdynamic heart conditions usually occur in:
- older patients
- women
- obese people,
- patients with diabetes,
- people with hypertension
What Causes a Hyperdynamic Left Ventricle?
One of the primary causes of a hyperdynamic left ventricle is hypertension. The increased blood pressure leads to left ventricular hypertrophy. As the heart has to pump harder, it grows bigger. Such an increase in cardiac muscle is referred to as left ventricular hypertrophy and can lead to hyperdynamic states [1].
Another significant cause is hypertrophic cardiomyopathy. This is a genetic disease in which a gene mutation in the heart causes thickening of the cardiac muscle. An abnormally big heart can have problems pumping blood properly. To function effectively, it will have to pump harder, leading to a hyperdynamic left ventricle [7, 8].
Also, diabetes and obesity are associated with a hyperdynamic left ventricle. In both of these conditions, the structure and function of the heart can change. This can lead to an increased heart rate and changes in the size of the heart’s chambers, resulting in hyperdynamic states [1].
Lastly, there is a strong association between age and a hyperdynamic left ventricle. The higher occurrence indicates that older age is also a factor in hyperdynamic left ventricle [1].
Are Hyperdynamic Left Ventricles Serious?
Yes, hyperdynamic left ventricles can be serious. This condition is not a normal function of the heart and is associated with increased mortality [1].
Patients with a hyperdynamic heart are often found to have diastolic dysfunction. Their hearts have a larger atrial size, the left ventricles have an increased mass, and the end diastolic volumes are higher. All those characteristics make the survival rates in this group lower. Compared to patients with a normal ejection fraction, patients with a hyperdynamic left ventricle have an increased risk of death by 56% [1].
A hyperdynamic heart does not increase the death risk only in individuals with cardiac disease. A hyperdynamic left ventricle more than doubles the risk of death in patients with COVID-19 [9].
Short-term mortality is also increased in septic patients with hyperdynamic left ventricles [10].
How is a Hyperdynamic Left Ventricle Diagnosed?
The diagnosis of a hyperdynamic left ventricle is based on imagining. Primarily used is echocardiography. This technique allows assessment of the systolic and diastolic functions and the ejection fraction [11, 12].
In atypical cases or when echocardiography is not optimal, cardiac magnetic resonance can be used. The cardiac picture acquired during this method allows the doctors to measure the volume and mass of both ventricles. Cardiac MRI also shows certain characteristic properties of the cardiac tissue [13].
Treatment of a Hyperdynamic Left Ventricle
The treatment of a hyperdynamic left ventricle often involves managing the underlying condition, such as hypertrophic cardiomyopathy. First-line treatment usually includes:
- antiplatelets,
- beta-blockers,
- angiotensin II receptor blockers,
- diuretics [14].
In specific cases, interventional treatment can be considered. When the patient does not respond to therapy or when an obstruction is found in the left ventricle, a septal myectomy or alcohol septal ablation can be used [15, 16].
However, the therapy should be tailored individually. For every patient, factors like the characteristics of the condition, lifestyle, age, and the doctor’s expertise should be taken into account [16].