The impact of aortic valve calcification on survival in patients with severe aortic stenosis

• Project/Area Number: 19K17522
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 53020:Cardiology-related
• Research Institution: Kobe City Medical Center General Hospital(First Clinical Division, Second Clinical Division, Third (2021); Kyoto University (2019-2020)
• Principal Investigator: TANIGUCHI TOMOHIKO 地方独立行政法人神戸市民病院機構神戸市立医療センター中央市民病院(第1診療部、第2診療部、第3診療部, 中央市民病院, 医長 (50837929)
• Project Period (FY): 2019-04-01 – 2022-03-31
• Project Status: Completed (Fiscal Year 2021)
• Budget Amount: ¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000); Fiscal Year 2021: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2020: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2019: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
• Keywords: CT / 大動脈弁狭窄症 / 経カテーテル的大動脈弁置換術 / 大動脈弁狭窄 / ＣＴ

Outline of Research at the Start

大動脈弁狭窄症における重症の基準としては、心臓超音波検査における、①大動脈弁最大通過血流速度≧4m/s、②大動脈弁平均圧較差≧40mmHg、③大動脈弁弁口面積≦1cm2のうち、いずれかを満たすことであるが、実臨床では③のみを満たし、最大通過血流速度、圧較差については中等症ASに分類されるLow gradient severe ASがしばしば見受けられ、重症度について迷うケースが存在する。この際には、弁変性の定量評価がキーとなると考えられる。本研究では、TAVI術前のCTにおける石灰化病変の定量評価と、心臓超音波検査におけるAS重症度の関連性を評価し、予後に影響を与える因子について検討する。

Outline of Final Research Achievements

Some patients are classified as severe aortic stenosis (AS) based on aortic valve area <1cm2 alone with less severe Vmax and mean aortic pressure gradient. There is considerable debate on the management of patients with low-gradient severe AS. Calcium score was significantly lower in patients with low-gradient severe AS than in those with high-gradient severe AS in ECG-gated computed tomography. Men had higher calcium score than women. Among low-gradient severe AS, approximately 40% patients had met the criteria of calcium scoring in the current guidelines. There was no significant difference of periprocedural complications between the two groups among patients who actually underwent TAVI.

Academic Significance and Societal Importance of the Research Achievements

本研究の結果から、大動脈弁狭窄症の診断においてCTでのCaスコアの有用性が示された一方で、Caスコアの重症度基準を満たさない症例も多く存在しており、Caスコアの限界が示唆された。今後Caスコアと長期予後との関連性を検討することで、大動脈弁狭窄症の更なる診断能の改善につながることが期待される

Research Products

• [Journal Article] Tailor-Made Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement in an Extremely High-Risk Patient (2022)
  • Author(s): Tomohiko Taniguchi, Hideo Chihara, Yuji Agawa, Taketo Hatano, Kenichi Ishizu, Shinpei Fujioka, Masaomi Hayashi, Tomohiro Kawaguchi, Akihiro Isotani, Shinichi Shirai, Kenji Ando
  • Journal Title: Circulation Journal Volume: 86 Issue: 3 Pages: 473
  • DOI: 10.1253/circj.CJ-21-0678
  • NAID: 130008163841
  • ISSN: 1346-9843, 1347-4820
  • Year and Date: 2022-02-25
  • Peer Reviewed
• [Journal Article] Intravascular Hemolysis After Transcatheter Aortic Valve-in-Valve Implantation for Degenerated Stentless Bioprosthesis (2021)
  • Author(s): Taniguchi Tomohiko、Shirai Shinichi、Isotani Akihiro、Ando Kenji
  • Journal Title: Circulation Journal Volume: 85 Issue: 2 Pages: 221
  • DOI: 10.1253/circj.CJ-20-1021
  • NAID: 130007975425
  • ISSN: 1346-9843, 1347-4820
  • Year and Date: 2021-01-25
  • Peer Reviewed
• [Journal Article] Elective Non-Cardiac Surgery in Patients With Severe Aortic Stenosis ― Observations From the CURRENT AS Registry ― (2020)
  • Author(s): Taniguchi Tomohiko、Morimoto Takeshi、Shiomi Hiroki、Ando Kenji、Shirai Shinichi、Kanamori Norio、Murata Koichiro、Kitai Takeshi、Kawase Yuichi、Kadota Kazushige、Miyake Makoto、Izumi Chisato、Minamino-Muta Eri、Kato Takao、Ishii Katsuhisa、Nagao Kazuya、Saito Naritatsu、Minatoya Kenji、Kimura Takeshi
  • Journal Title: Circulation Journal Volume: 84 Issue: 7 Pages: 1173-1182
  • DOI: 10.1253/circj.CJ-20-0026
  • NAID: 130007864271
  • ISSN: 1346-9843, 1347-4820
  • Year and Date: 2020-06-25
  • Peer Reviewed