I’m not sure about LVH, at 4.2 your aneurysm is on the small side though. The main way to reduce the possibility of growth and future surgery (you know you have it so you can plan for repair if it ever gets to a critical size and take dissection out of the picture), is to maintain a healthy BP. Hi BP is the worst enemy of an aneurysm. Maintain a healthy lifestyle, exercise and keep yourself active but avoid any exertion that makes you hold your breath or grunt while doing it (lifting heavy weights, some abs exercises, etc) BP spikes for a few seconds while doing that and that is detrimental to your aneurysm.

The first thing in my mind is to find a cardiologist who specializes in aortic diseases, he/she will measure the size more accurately (CT rather than echo) and establish a protocol for follow up to determine the rate of growth (if any) and the frequency of follow ups. He/she would also weigh in the other issues (LVH).

I had a 5.2 cm ascending aortic aneurysm repaired in 2020, get seen every year by my cardiologist for life.

Again the LVH may be more critical than your aneurysm right now so finding the right cardiologist is paramount.

You know you have the aneurysm and can monitor and plan, not everyone has that opportunity.

Wish you the best!!