Left Ventricular Hypertrophy on CT Scan

[jeanette1952]

I am a 65 year oId female.  I had had Cardiac CT scan on 2/7/17 for an ablation for AFib that took place on 2/13/17. No problems with ablation so far. No AFib episodes at all after ablation. Hadn't had one 7 months prior to ablation. The cardiac scan showed some troubling findings. Showed that I had good LV and RV systolic function. The RV was unremarkable. It said left ventricular hypertrophy....did not indicate mild, moderate, etc. It measured 14 mm. Also said LV chamber is small.  The ejection fraction was 73% which I was told always occurs on nuclear testing (it seeming high that is). Also said I had extensive mitral annular stenosis as well as "diffuse" thoracic aortic and aortic arch stenosis. I have no shortness of breath or any kind of chest pain. I had an echo done in on June 17, 2017 which did not mention the hypertrophy.  The aortic and mitral valve problems were noted though. The ejection fraction was 55-65%. The one from echo is supposed to be the valid estimate. I am very frightened about the left ventricular hypertrophy. Is it coming from a valve problem? My blood pressure has been well controlled from some time. I walk every day and I am scared to to it now but still do. The EP was good and did a great job on the ablation but did not address the other issues. I had them fax a copy to my regular cardiologist and my PCP.  I will see the EP's PA on 3/28/17 about how I am doing regarding ablation. I guess since the EP is not going to contact me I will make an appointment with my regular cardiologist. The stuff I read on the internet was very frightening...this could turn into heart failure. I guess my question is how could this happen in just a few months? I try to eat properly and exercise. Can it be reversed? My anxiety is getting the best of me. So scared...I have two little grandchildren. Hope reversal is a possibility. Thanks in advance for any response.  

[jeanette1952]

One thing I forgot to mention if that the right atrium went from 4.3 to 4.9 (on the CT scan in AP dimensions) in less than 7 months. 4.3 was the reading on the last echo done on JUNE 17, 2016. Sorry about that echo date in first entry. I had one "regular" episode of AFib since then (7/18/16) and three smaller ones...last one I ever had was 7/25/17.  That is a lot of enlargement in such a small amount of time. All this is very scary. You are right I should hold on to the good findings and  wait to see my cardiologist. Thanks for answering me. Made me feel better. But I realize that 65 is old and anything can happen now. I take solace in the fact that I have tried very hard to take care of myself these last seven years. Lost over 100 lbs. and drastically changed my diet and also started walking on a regular basis. Can't do anything about genetics though.

Did anyone ever find out what happened to ed34? You have really stepped up to his spot on here. Thank you again for your kindness Ger.        

[Ger57]

There are often big differences between measurements from different modalities (CT and echo). Comparing results is therefore tricky.

Then there is the difference in interpretation of the results by the examiner.
A difference of 6mm is not so surprising to me.

RA can get enlarged from RV problems or tricuspid valve leakage. You do not have that.
RA enlargement can sometimes be caused by Afib.

Lets assume that the increase is real:
it could then be a result from your past Afib episodes. In that case there is a good chance that the size will go back to normal values again, now that the Afib is gone.

The fault we patients often make is that we focus on an isolated measurement and when it is abnormal or deviates from previous measurement we are alarmed.
The cardiologist will look at the whole picture and not at one isolated measurement. If action was needed from the CT results, your cardiologist would surely have contacted you.
I think you will be just fine.

Yes, we surely miss Ed and his expert knowledge on cardiac matters.
I asked around but no one seems to know what happened...

[jeanette1952]

Thank you so very much. Your encouragement has been invaluable to me. The cardiologist has not had time to contact me yet but I am calling for an appointment on Monday. Thanks again for putting all of this into perspective for me. Feel so much better now!! Sorry that no one has ever found out anything about ed34. I will let you know what I find out when I go to cardiologist. Thanks again.

[jeanette1952]

I just noticed something else on that report. I haven't looked at it since I posted this the other day. Guess I just did not see it before. Next to where it states that I have LVH of 14 mm there is a statement saying "The LV chamber is relatively small." What does that mean? 14 mm should not make it that small should it?

[Ger57]

Normal wall thickness is <10mm, so the additional 4mm does make the ventricle a little but not remarkably smaller.

Normal size for the LV in women is 3,9-5,3cm.
I do not know what they exactly mean when they say small. The LV would be remarked as abnormal when it was below the 3,9cm, so I guess it was measured at the lower side of the normal range.

[jeanette1952]

Went to cardiologist today. And you were right. He said trying to compare a CT scan with and ECHO was like comparing apples and oranges. Said everything was fine. Again, thanks so much for your input Ger57.

[Ger57]

Dear Jeanette,

Let me start by congratulating you with the outcome of the ablation, although it is still early after the procedure.

In general:
Hypertrophy can develop in a couple of months when there is a strong cause for it. It can also reverse when the cause is taken away.
Hypertrophy does not develop from afib or mitral stenosis.


Do not overreact on the findings from the CT.
The CT shows good LV and RV function and EF.
You feel well, no chest discomfort, so it can not be too bad.

Your EP is not going to comment on the findings from the inside of your heart, I think. You need to talk to your cardiologist about that.

I suppose you mean that your echo was done on  June 17, 2016?
A repeat echo seems a good idea to check if the findings of the CT are also seen in the echo, which is the instrument of choice for function of valves, heart sizes, EF.

With the info you gave, I do not see a cause for hypertrophy. I would not be surprised if a repeat echo shows no hypertrophy at all.

Hope this helps you a little to ease your mind.

Enjoy your grandchildren,

Ger (also with 2 grandchildren :-) )