Left Ventricular Hypertrophy (LVH) is a risk factor for major cardiovascular diseases as stroke, myocardial infarction and sudden death, and is sustained by several hemodynamic and non-hemodynamic mechanisms. A wide spectrum of alterations in left ventricular hypertrophy geometric pattern can take the form of normal left ventricle, concentric left ventricular remodeling, concentric left ventricular hypertrophy, eccentric LVH. Hemodynamic and anatomic characteristics of LVH are represented by the alteration of coronary blood flow, endothelial dysfunction, extracellular collagen deposition and ventricular fibrosis. However, other biological phenomena such as genotype, gender, body size, environmental factors can influence left ventricular mass. The most important mechanism remains the activation of neurohormonal systems (first of all, renin-angiotensin system, secondarily catecolamines, insulin and leptin). Actual data cannot explain some LVH characteristics (LVH pattern development, LVH regression), so several open questions remain to be clarified through further investigations.