A comparative analysis of structural and functional remodeling of the heart in patients with valvular heart defects

Authors:

Smotrina Svetlana Vladimirovna – doctor of Medical and Social Expertise; Expert Panel No. 4, Federal State Institution Main Bureau of Medical and Social Expertise for Moscow of the Ministry of Labour and Social Protection of the Russian Federation; 36 Priorova Street, 125130 Moscow, Russian Federation, e-mail: elata2010@yandex.ru, https://orcid.org/0009-0002-1168-4228

Ponomarenko Gennadiy Nikolaevich — Oorresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Grand PhD in Medical sciences (Dr. Med. Sci), Professor, Director General of the Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Head of the Department of Physical and Rehabilitation Medicine of the North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Avenue, 195067, St. Petersburg, Russian Federation; e-mail: ponomarenko_g@mail.ru; https://orcid.org/0000-0001-7853-4473.

Zapariy Sergey Petrovich – Honored Doctor of the Russian Federation, Grand PhD in Medical sciences (Dr. Med. Sci), Acting First Deputy Head – Chief expert on medical and social expertise, Federal State Institution Main Bureau of Medical and Social Expertise for Moscow Ministry of Labour and Social Protection of the Russian Federation, 36 Priorova Street, 125130 Moscow, Russian Federation; e-mail: zaparijsp@mail.ru, https://orcid.org/0000-0002-4636-1130.

Annotation:

Introduction. Population aging in Russia is leading to an increase in disability due to valvular heart disease (VHD). VHD is accompanied by myocardial remodeling, which determines the clinical course and severity of impaired cardiovascular system function. The interpretation of echocardiographic parameters for the purposes of medical and social expertise (MSE) requires greater standardization in assessing the degree of impairment of cardiovascular system function.

Aim. To study the features of structural and functional remodeling of the heart in various anatomical types of valvular defects in patients examined at the Bureau of Medical and Social Expertise.

Materials and methods. A retrospective single-center study enrolled 545 patients examined between 2017 and 2024. Indexed left ventricular (LV) echocardiographic parameters, ejection fraction (EF), and systolic pulmonary artery pressure (sPAP) were analyzed. The groups were formed according to the type of defect: aortic (AV, n=185), mitral (MV, n=152), and multivalvular (n=208). Statistical analysis was performed using StatTech v. 4.8.11 software. Quantitative data are presented as Me (Q1-Q3). Comparison of three or more groups was carried out using the Kruskal – Wallis test with subsequent pairwise comparisons (Dunn’s test with Holm’s correction); p<0,05 was considered statistically significant.

Results. According to the results of the analysis, the relationship between the anatomical type of defect and the nature of remodeling was revealed. In those examined with isolated aortic malformation (AK), concentric hypertrophy of the left ventricle (LV) prevailed, as evidenced by the highest values of the thickness of the interventricular septum (13 mm) and the posterior wall of the LV (12 mm) against the background of preserved ejection fraction (EF) (58 %). In those with mitral and multi-valve defects, eccentric remodeling was revealed, which was characterized by statistically significantly more pronounced dilation of the heart chambers and impaired LV function: the LV enddiastolic size index reached 28.1 mm/m2 with multi-valve defects versus 25.2 mm/m2 in the AK group (p<0.001), the ejection fraction decreased to 52.0 % (p<0.001). In parallel, the degree of pulmonary hypertension increased: systolic pressure in the pulmonary artery increased to 37 [30; 46] mmHg with multi-valve defects compared with 30 mmHg in the AK group (p<0.001). There was also a significant increase in the size of the left atrium in the groups with mitral valve involvement. There were no statistically significant differences in the LV myocardial mass index (LVMI) between the groups (p=0.249), which underlines the importance of assessing not only the total mass of the myocardium, but also the pattern of its remodeling in expert practice.

Discussion. A relationship was identified between the anatomical type of VHD and the pattern of cardiac remodeling. Isolated AV disease was associated with concentric LV hypertrophy. In contrast, mitral and multivalvular diseases were linked to eccentric remodeling, which was accompanied by more pronounced LV chamber dilation, reduced EF, and the development of pulmonary hypertension. These findings confirm the necessity of a comprehensive assessment of cardiac remodeling parameters during medical and social expert evaluation.

Conclusion. The anatomic type of VHD determines the remodeling profile and the severity of cardiovascular functional impairment: mitral and multivalvular disease are associated with greater chamber dilatation, reduced systolic function, and higher pulmonary pressures compared with isolated aortic disease. A composite of echocardiographic indices can serve as an objective basis for grading the severity of cardiovascular functional impairment within the MSE framework.

List of cited literature:

1. Shlyakhto EV (ed.) Kardiologiya: natsional’noe rukovodstvo [Cardiology: National Guidelines]. 2nd ed., Moscow: GEOTAR-Media 2015. (in Russian).

2. Assotsiatsiya serdechno-sosudistykh khirurgov Rossii, Rossiiskoe kardiologicheskoe obshchestvo [Association of Cardiovascular Surgeons of Russia, Russian Society of Cardiology] Klinicheskie re-komendatsii. Mitral’naya nedostatochnost’ [Clinical Guidelines. Mitral Regurgitation]. 2024. Available at: https://cr.minzdrav.gov.ru/view-cr/881_1 (accessed 17.08.2025). (in Russian)

3. Rabochaya gruppa po vedeniyu patsientov s klapa-nnoi bolezn’yu serdtsa Evropeiskogo kardiologich-eskogo obshchestva (ESC) i Evropeiskoi assotsiat-sii kardio-torakal’noi khirurgii (EACTS) [The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)] (2022) 2021 Rekomendatsii ESC/EACTS po vedeniyu patsientov s klapannoi bolezn’yu serdtsa [ESC/EACTS Guidelines for the management of patients with valvular heart disease]. Rossiiskii kardio-logicheskii zhurnal [Russian Journal of Cardiology], 2021. Vol. 27, no 7, pp. 5160. DOI:10.15829/1560-4071-2022-5160. (in Russian).

4. Novikov VI, Novikova TN. Klapannye poroki serdt-sa [Valvular Heart Diseases]. Moscow: MEDpressinform. 2024. (in Russian).

5. Yang LT, Enriquez-Sarano M, Scott CG [et al.] Concomitant Mitral Regurgitation in Patients With Chronic Aortic Regurgitation. Journal of the American College of Cardiology, 2020. Vol. 76, no 3, pp. 233-246. DOI:10.1016/j.jacc.2020.05.051.

6. Vachiery J, Tedford RJ, Rosenkranz S [et al.] Pulmonary hypertension due to left heart disease. European Respiratory Journal, 2019. Vol. 53, no 1, рp. 1801897. DOI:10.1183/13993003.01897-2018.

7. Maeder M, Weber L, Rickli H. Pulmonary hypertension in aortic valve stenosis. Trends in Cardiovascular Medicine, 2022. Vol. 32, no 2, pp. 73-81. DOI:10.1016/j. tcm.2020.12.005.

8. Patel B, D’Souza S, Sahni T, Yehya A. Pulmonary hypertension secondary to valvular heart disease: a state-of-the-art review. Heart Failure Reviews, 2023. Vol. 29, no 1, pp. 277-86. DOI:10.1007/s10741-023-10372-9.

9. Wei Z., Shao X., An Z. [et al.] The impact of pulmonary hypertension on prognosis in moderate-to-se-vere mitral regurgitation patients treated with transcatheter edge-to-edge mitral valve repair: a comprehensive meta-analysis. Frontiers in Cardiovascular Medicine, 2025. Vol. 11, pp. 1489674. DOI:10.3389/ fcvm.2024.1489674.

10. Oh J, Lee S, Lee S [et al.] Prognostic impact of left ventricular mass regression after transcatheter aortic valve replacement in patients with left ventricular hypertrophy. International Journal of Cardiology, 2021. Vol. 332, pp. 60-6. DOI:10.1016/j.ijcard.2021.03.053.

11. Falcao-Pires I, Ferreira AF, Trindade F [et al.] () Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function. European Journal of Heart Failure, 2024;26(7):1454-79. DOI:10.1002/ejhf.3264.

12. Tarasevich SV, Zherko OM, Krachak DI, Galitskaya SS. Strukturno-funktsional’noe remodelirovanie levogo zheludochka posle bioprotezirovaniya aortal’nogo klapana po povodu aortal’nogo stenоза [Structural and functional left ventricular remodeling after bio-prosthetic aortic valve replacement for aortic stenosis]. Kardiologiya v Belarusi [Cardiology in Belarus], 2024;27(4):312-20. DOI:10.34883/PI.2024.16.4.005. (in Russian).