Functional severity of coronary artery disease in patients with aortic valve stenosis

• Project/Area Number: 16K09480
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: Wakayama Medical University
• Principal Investigator: Matsuo Yoshiki 和歌山県立医科大学, 医学部, 講師 (20420755)
• Co-Investigator(Kenkyū-buntansha): 久保 隆史 和歌山県立医科大学, 医学部, 准教授 (30316096) ; 赤阪 隆史 和歌山県立医科大学, 医学部, 教授 (70322584)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥3,640,000 (Direct Cost: ¥2,800,000、Indirect Cost: ¥840,000); Fiscal Year 2018: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000); Fiscal Year 2017: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2016: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
• Keywords: 大動脈弁狭窄症 / 冠動脈疾患 / 冠循環生理 / 冠血流速予備能 / 経カテーテル的大動脈弁置換術 / 冠血流予備能 / 心筋血流予備量比 / 医学 / 臨床医学 / 循環器内科学

Outline of Final Research Achievements

In this study, we sought to evaluate the effect of aortic valve stenosis on coronary circulation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Coronary flow velocity reserve (CFVR) of the left anterior descending artery was assessed by adenosine transthoracic echocardiography at baseline and immediately post-TAVI. Post-TAVI flow velocity at rest was lower than baseline flow velocity at rest (22.0±8.3 versus 28.3±8.4 cm/s, p<0.01). Post-TAVI CFVR was significantly higher than baseline CFVR (1.97±0.40 versus 1.70±0.33, p<0.01).

Academic Significance and Societal Importance of the Research Achievements

大動脈弁狭窄症は高齢化とともに罹患率が増加し、冠動脈疾患を高率に合併する。一方で大動脈弁狭窄症が冠循環に及ぼす影響は明らかではなく、大動脈弁狭窄症に合併した冠動脈狭窄の評価法は確立されていない。本研究により、冠血流速予備能は、大動脈弁狭窄症に対する経カテーテル的大動脈弁置換術後、すみやかに改善することが明らかとなった。本研究結果は、大動脈弁狭窄症の手術前後の冠循環動態の動的な変化により、大動脈弁狭窄症に合併する冠動脈疾患の機能的狭窄度が変化する可能性を示唆する。したがって、大動脈弁狭窄症に合併した冠動脈疾患に対しては、大動脈弁置換術と血行再建の時期を考慮した治療戦略を構築する必要がある。

Research Products

• [Journal Article] Extent of the difference between microcatheter and pressure wire-derived fractional flow reserve and its relation to optical coherence tomography-derived parameters (2020)
  • Author(s): Matsuo Yoshiki、Shiono Yasutsugu、Kashiyama Kuninobu、Ino Yasushi、Kubo Takashi、Akasaka Takashi
  • Journal Title: IJC Heart & Vasculature Volume: 27 Pages: 100500-100500
  • DOI: 10.1016/j.ijcha.2020.100500
  • Peer Reviewed
• [Journal Article] Y字型人工血管側枝を代替アクセスルートとした経カテーテル的大動脈弁置換術 (2020)
  • Author(s): 武田惇平, 松尾好記, 久保隆史, 赤阪隆史
  • Journal Title: 心臓 Volume: 52 Pages: 22-26
  • NAID: 130008062332
  • Peer Reviewed
• [Journal Article] Association of Hemodynamic Severity With Plaque Vulnerability and Complexity of Coronary Artery Stenosis: A Combined Optical Coherence Tomography and Fractional Flow Reserve Study. (2019)
  • Author(s): Matsuo Y, Higashioka D, Ino Y, Shiono Y, Kitabata H, Terada K, Emori H, Katayama Y, Taruya A, Nishiguchi T, Shimamura K, Kameyama T, Kuroi A, Yamano T, Tanimoto T, Tanaka A, Hozumi T, Kubo T, Akasaka T.
  • Journal Title: JACC. Cardiovascular imaging Volume: 12 Issue: 6 Pages: 1103-1105
  • DOI: 10.1016/j.jcmg.2018.11.023
  • Peer Reviewed
• [Journal Article] In vivo optical coherence tomography imaging and histopathology of healed coronary plaques (2018)
  • Author(s): Shimokado Aiko、Matsuo Yoshiki、Kubo Takashi、Nishiguchi Tsuyoshi、Taruya Akira、Teraguchi Ikuko、Shiono Yasutsugu、Orii Makoto、Tanimoto Takashi、Yamano Takashi、Ino Yasushi、Hozumi Takeshi、Tanaka Atsushi、Muragaki Yasuteru、Akasaka Takashi
  • Journal Title: Atherosclerosis Volume: 275 Pages: 35-42
  • DOI: 10.1016/j.atherosclerosis.2018.05.025
  • Peer Reviewed / Open Access
• [Journal Article] Current Clinical Applications of Intravascular Optical Coherence Tomography in Coronary Artery Disease (2018)
  • Author(s): Kubo Takashi、Matsuo Yoshiki、Ino Yasushi、Kitabata Hironori、Shimamura Kunihiro、Shiono Yasutsugu、Terada Kosei、Emori Hiroki、Katayama Yosuke、Akasaka Takashi
  • Journal Title: Annals of Nuclear Cardiology Volume: 4 Issue: 1 Pages: 127-131
  • DOI: 10.17996/anc.18-00054
  • NAID: 130007474493
  • ISSN: 2189-3926, 2424-1741
  • Open Access
• [Journal Article] Coronary flow reserve (2018)
  • Author(s): 松尾好記. 久保隆史
  • Journal Title: 月間循環器内科 Volume: 83 Pages: 90-96
  • NAID: 40021454696
• [Presentation] Influence of the Tilt Angle of Transcatether Aortic Valve Implantation on a Newonset Conduction Abnormality (2019)
  • Author(s): Yoshiki Matsuo, Teruaki Wada, Takahiro Nishi, Kunihiro Shimamura, Hiroki Emori, Daisuke Higashioka, Yosuke Katayama, Naoki Maniwa, Masahiro Takahata, Manabu Kashiwagi, Yasutsugu Shiono, Akio Kuroi, Hironori Kitabata, Yasushi Ino, Takashi Kubo, Atsushi Tanaka, Takeshi Hozumi, Takashi Akasaka
  • Organizer: The 83rd Annual Scientific Meeting of the Japanese Circulation Society
• [Presentation] Effect of Transcatheter Aortic Valve Implantation on Coronary Hemodynamics in Patients with Severe Aortic Stenosis (2019)
  • Author(s): Teruaki Wada, Yoshiki Matsuo, Takahiro Nishi, Hiroki Emori, Daisuke Higashioka, Yosuke Katayama, Manabu Kashiwagi, Kunihiro Shimamura, Yasutsugu Shiono, Akio Kuroi, Hironori Kitabata, Yasushi Ino, Takashi Kubo, Atsushi Tanaka, Takeshi Hozumi, Takashi Akasaka
  • Organizer: The 83rd Annual Scientific Meeting of the Japanese Circulation Society
• [Presentation] A case of early valve thrombosis after transcatheter aortic valve implantation (2018)
  • Author(s): Wada T, Matsuo Y, Nishi T, Kashiwagi M, Shimamura K, Ota S, Shiono Y, Kuroi A, Kameyama T, Kitabata H, Ino Y, Kubo T, Tanaka A, Hozumi T, Akasaka T
  • Organizer: PCR Tokyo Valves 2018
  • Int'l Joint Research
• [Presentation] Natural history of nonculprit coronary plaques in patients with acute coronary syndrome caused by plaque rupture and plaque erosion (2018)
  • Author(s): 松尾 好記、久保 隆史、西 貴弘、東岡 大輔、江守 裕紀、片山 陽介、和田 輝明、馬庭 直樹、島村 邦宏、塩野 泰昭、猪野 靖、北端 宏規、赤阪 隆史
  • Organizer: 第27回日本心血管インターベンション治療学会学術集会
• [Presentation] TAVI弁留置後の急性高度大動脈弁閉鎖不全症 (2018)
  • Author(s): 松尾 好記・和田 輝明・柏木 学・西 貴弘・寺田 幸誠 江守 裕紀・東岡 大輔・片山 陽介・嶋村 邦宏・猪野 靖 北端 宏規・竹本 和司・穂積 健之・田中 篤・久保 隆史・赤阪 隆史
  • Organizer: ストラクチャークラブ・ジャパン ライブデモンストレーション2018
• [Presentation] Differences in nonculprit lesion characteristics between ACS patients with plaque rupture and those with plaque erosion (2018)
  • Author(s): Matsuo Y
  • Organizer: Korea Mayo Conference
  • Invited
• [Presentation] Differences in nonculprit lesion characteristics between ACS patients with plaque rupture and those with plaque erosion (2018)
  • Author(s): Matsuo Y, Kubo T, Ino Y, Kitabata H, Shimamura K, Ota S, Kashiwagi M, Shiono Y, Kuroi A, Hozumi T, Tanaka A, Akasaka T
  • Organizer: The 82nd Annual Scientific Meeting of the Japanese Circulation Society
  • Int'l Joint Research
• [Presentation] Association of High-risk Plaque Morphology with Hemodynamic Significance of Coronary Artery Stenosis (2017)
  • Author(s): Matsuo Y, Higashioka D, Kubo T, Nishiguchi T, Ozaki Y, Kuroi A, KameyamaT, Yamano T, Ino Y, Kitabata H, Yamaguchi T, Takemoto K, Tanaka A, Hozumi T, Akasaka T
  • Organizer: European Society of Cardiology Congress 2017
  • Int'l Joint Research
• [Presentation] Fate of Silent Plaque Rupture: Serial OCT and Clinical Follow-up Study (2017)
  • Author(s): Yoshiki Matsuo
  • Organizer: Konyang-Cardiology Conference 2017
  • Place of Presentation: Daejeon, South Korea
  • Invited
• [Presentation] Intracoronary imaging of healed coronary plaques (2016)
  • Author(s): Yoshiki Matsuo
  • Organizer: Konyang-Cardiology Conference 2016
  • Place of Presentation: Daejeon, South Korea
  • Invited
• [Book] 内科学書３「循環器疾患・腎・尿路疾患」 (2019)
  • Author(s): 松尾好記, 赤阪隆史
  • Total Pages: 4
  • Publisher: 中山書店