Comprehensive Assessment of Left Ventricular Mass, Its Derived Indices, and Relative Wall Thickness in Ischemic Heart Disease

BACKGROUND: Ischemic heart disease (IHD) remains a leading cause of global cardiovascular mortality. Left ventricular (LV) remodeling, characterized by changes in LV mass index (LVMI) and relative wall thickness (RWT), is a central pathological process linking myocardial ischemia to adverse clinical outcomes. SUMMARY: This narrative review synthesizes current evidence on the pathophysiological mechanisms, prognostic value, and clinical implications of LVMI and RWT across the IHD spectrum. Convergent findings demonstrate that both LVMI and RWT are robust, independent predictors of adverse cardiovascular events. Among remodeling patterns, concentric hypertrophy (elevated LVMI with elevated RWT) is consistently associated with the highest risk across imaging modalities. These parameters offer incremental prognostic value beyond traditional risk factors, and longitudinal changes provide critical insights into therapeutic response. KEY MESSAGES: (1) Integrated assessment of LVMI and RWT is essential for accurate risk stratification and personalized management in IHD. (2) Concentric hypertrophy identifies the highest risk phenotype and warrants intensive preventive strategies. (3) Future research should focus on establishing standardized, modality-specific therapeutic thresholds and validating LVMI and RWT as surrogate endpoints in clinical trials.