Katagiri Yuki, Yamasaki Kazumasa, Hatanaka Noriyuki, Bota Hiroki, Tani Tomoyuki, Koga Tomonori, Setogawa Yuki, Misawa Manabu, Ueda Takashi, Yamazaki Seiji
Department of Cardiology, Sapporo Higashi Tokushukai Hospital Sapporo Japan.
Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital Sapporo Japan.
Circ Rep. 2022 Apr 28;4(6):274-284. doi: 10.1253/circrep.CR-22-0035. eCollection 2022 Jun 10.
In patients with aortic stenosis (AS), measurement of aortic valve calcification (AVC) using computed tomography (CT) is recommended in cases where echocardiographic measurements are inconclusive. However, sex-specific AVC thresholds proposed in the guidelines for predicting severe AS (women: 1,200 arbitrary units [AU]; men: 2,000 AU) are based on studies from Western countries. We retrospectively included 512 Japanese patients with at least moderate AS who underwent transthoracic echocardiography and CT. AVC was quantified using the Agatston method. AVC was positively correlated with peak aortic jet velocity and mean transvalvular gradient (mPG), and negatively correlated with aortic valve area (AVA) and the AVA index (AVAi). In 257 patients with concordant AS grading (152 severe AS [AVAi ≤0.6 cm/m, mPG ≥40 mmHg], 105 moderate AS [AVAi >0.6 cm/m, mPG <40 mmHg]), receiver operating characteristic curve analysis of AVC predicting severe AS yielded an area under the curve of 0.91 (95% confidence interval [CI] 0.87-0.95; P<0.001) in women and 0.86 (95% CI 0.75-0.98; P<0.001) in men. The optimal thresholds (women: 1,379 AU; men: 1,802 AU) were close to those proposed in the guidelines. The diagnostic accuracy of the thresholds in the guidelines was similar to that of the optimal thresholds. The sex-specific AVC thresholds proposed in international guidelines can be applied to Japanese AS patients, yielding similar diagnostic accuracy as the optimal cut-off derived from the study patients.
在主动脉瓣狭窄（AS）患者中，若超声心动图测量结果不明确，建议使用计算机断层扫描（CT）测量主动脉瓣钙化（AVC）。然而，预测重度AS的指南中提出的性别特异性AVC阈值（女性：1200任意单位[AU]；男性：2000 AU）是基于西方国家的研究。我们回顾性纳入了512例至少为中度AS且接受经胸超声心动图和CT检查的日本患者。使用阿加斯顿方法对AVC进行量化。AVC与主动脉峰值射流速度和平均跨瓣压差（mPG）呈正相关，与主动脉瓣面积（AVA）和AVA指数（AVAi）呈负相关。在257例AS分级一致的患者中（152例重度AS[AVAi≤0.6 cm/m²，mPG≥40 mmHg]，105例中度AS[AVAi>0.6 cm/m²，mPG<40 mmHg]），AVC预测重度AS的受试者工作特征曲线分析显示，女性曲线下面积为0.91（95%置信区间[CI] 0.87 - 0.95；P<0.001），男性为0.86（95%CI 0.75 - 0.98；P<0.001）。最佳阈值（女性：1379 AU；男性：1802 AU）与指南中提出的阈值相近。指南中阈值的诊断准确性与最佳阈值相似。国际指南中提出的性别特异性AVC阈值可应用于日本AS患者，诊断准确性与从研究患者得出的最佳截断值相似。
