[Paradigms and paradoxes of left ventricular hypertrophy: from the research laboratory to the clinical consultation].

Cardiac hypertrophy can occur as an adaptative response to increased cardiac workload. Different types of cardiac hypertrophy arise from a combination of genetic, physiologic, and environmental factors. When hypertophic growth of the heart leads to left ventricular dysfunction and heart failure, the response is considered as maladaptive or pathological hypertrophy. After analyzed left ventricular functional and structural changes in rats induced by arterial hypertension, banding of aortic root, isoproterenol administration, or myocardial infarction, as well as in patients with arterial hypertension, aortic stenosis, or hypertrophic miocardiopathy, we found a maladaptive response considered as pathological hypertrophy. However, the adaptation of the left ventricle, found in response to physical activity or to pregnancy in humans, seems to help the heart adapt to the increase in workload acting as physiological hypertrophy. These considerations allow us to speculate for the use of future interventions to stimulate the development of physiological hypertrophy in several pathological situations or to change a pathological into a physiological response.