Key result
Although patients with aortic stenosis had a significantly prolonged initial upstroke time compared to normal controls (105 vs 55 msec, p<0.001), carotid pulse indices could not predict the severity of the stenosis.
Why the study?
Can external carotid pulse tracing indices predict the severity of aortic stenosis or correlate with left ventricular performance?
Cross-Sectional (n=43)
No
Can external carotid pulse tracing indices predict the severity of aortic stenosis or correlate with left ventricular performance?
External carotid pulse tracings can distinguish patients with aortic stenosis from normal subjects but cannot reliably predict the hemodynamic severity of the valvular obstruction.
Carotid pulse indices should not guide aortic stenosis severity assessment; leaves open whether refined tracings correlate with hemodynamics in prospective studies.
The morphology of the externally recorded carotid pulse tracing was studied in 33 patients with valvular aortic stenosis for indices of severity. Comparisons were made with 10 normal controls. In aortic stenosis, initial upstroke time (IUT) of the carotid pulse, and left ventricular ejection time index were significantly higher and the rate of rise of the carotid pulse was slower than in the control group. Severity of stenosis (calculated valve area and mean pressure gradient) could not be predicted, however, from any of these indices. The IUT of the carotid pulse did correlate well with mean velocity of circumferential fiber shortening (mVcf) (r=-0.72). The rate of rise of the carotid pulse had also a correlation with mVcf(r=0.66). However, other commonly used hemodynamic indices (cardiac index, systemic vascular resistance, stroke volume, and ejection fraction) did not have a good correlation with IUT and rate of rise of the carotid pulse. These results suggest that we are able to separate by carotid pulse tracings aortic stenosis from normal subjects, but we cannot say what is the degree of severity of aortic stenosis from analysis of the external carotid pulse recording.
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Ichiyasu et al. (1980) conducted a cross-sectional in Valvular aortic stenosis (n=43). Valvular aortic stenosis vs. Normal controls was evaluated on Initial upstroke time (IUT) of the carotid pulse (p=<0.001). Although patients with aortic stenosis had a significantly prolonged initial upstroke time compared to normal controls (105 vs 55 msec, p<0.001), carotid pulse indices could not predict the severity of the stenosis.
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