Left ventricular hypertrophy is a non-specific physiological or maladaptive 
cardiac response to a large array of stimuli mediated by exercise and numerous 
cardiac and systemic diseases. The precise characterization and quantification 
of left ventricular hypertrophy may allow a more timely diagnosis of the 
underlying condition. The clinical reference standard to assess left ventricular 
hypertrophy is echocardiography, but a comprehensive description of how to 
approach this frequent finding in clinical practice is lacking. The current 
review systematically describes the typical echocardiographic patterns of 
important types of cardiac hypertrophy using both established and advanced 
imaging modalities. In hypertrophic obstructive cardiomyopathy a markedly 
reduced regional systolic function is found in the prominent thickened septum, 
whereas in essential arterial hypertension a typical concentric left ventricular 
hypertrophy with a less prominent basal septal bulge is present. The 
echocardiographic characteristics of cardiac amyloidosis are ventricular 
hypertrophy with sparkling granular myocardial texture and a small epicardial 
effusion. In addition, the strain rate curve for longitudinal function shows a 
typically reduced function which reaches maximum already in early systole. The 
typical feature of Friedreich cardiomyopathy is concentric left ventricular 
hypertrophy and sparkling granular texture with preserved regional systolic 
function. In Fabry cardiomyopathy a prominent papillary muscle is presented and 
a typical strain rate curve can be extracted from the basal lateral wall, 
indicating replacement fibrosis. Prominent hypertrabecularisation (ratio of 
non-compacted to compacted myocardium >2) in the apical and mid left ventricular 
segments is typical for non-compaction cardiomyopathy. Knowledge of these 
typical echocardiographic features enables the cardiologist to distinguish 
between the different hypertrophic entities, thus paving the way to early 
diagnosis.