Key result
The presence of 'pulsus tardus et parvus' in the common and internal carotid arteries was highly predictive of moderate-to-severe aortic valve stenosis (OR 1158.5).
Why the study?
Neurovascular ultrasound Doppler flow characteristics in epiaortic arteries may predict aortic valve disease in ischemic stroke patients but their diagnostic value is unclear.
Do specific Doppler flow characteristics on neurovascular ultrasound of epiaortic arteries predict the presence of aortic valve disease in patients with ischemic stroke?
Cohort (n=1,320)
Single-blind
No
Do specific Doppler flow characteristics on neurovascular ultrasound of epiaortic arteries predict the presence of aortic valve disease in patients with ischemic stroke?
Specific qualitative Doppler flow characteristics in the common and internal carotid arteries during routine neurovascular ultrasound are highly predictive of moderate-to-severe aortic valve disease in patients with ischemic stroke.
May flag aortic stenosis on routine carotid Doppler in stroke; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND AND AIMS: Neurovascular ultrasound (nvUS) of the epiaortic arteries is an integral part of the etiologic workup in patients with ischemic stroke. Aortic valve disease shares similar vascular risk profiles and therefore not only presents a common comorbidity, but also an etiologic entity. The aim of this study is to investigate the predictive value of specific Doppler curve flow characteristics in epiaortic arteries and the presence of aortic valve disease. METHODS: Retrospective, single-center analysis of ischemic stroke patients, both receiving full nvUS of the extracranial common- (CCA), internal- (ICA) and external carotid artery (ECA) and echocardiography (TTE/TEE) during their inpatient stay. A rater blinded for the TTE/TEE results investigated Doppler flow curves for the following characteristics: 'pulsus tardus et parvus' for aortic valve stenosis (AS) and 'bisferious pulse', 'diastolic reversal', 'zero diastole' and 'no dicrotic notch' for aortic valve regurgitation (AR). Predictive value of these Doppler flow characteristics was investigated using multivariate logistic regression models. RESULTS: Of 1320 patients with complete examination of Doppler flow curves and TTE/TEE, 75 (5.7%) showed an AS and 482 (36.5%) showed an AR. Sixty-one (4.6%) patients at least showed a moderate-to-severe AS and 100 (7.6%) at least showed a moderate-to-severe AR. After adjustment for age, coronary artery disease, arterial hypertension, diabetes mellitus, smoking, peripheral arterial disease, renal failure and atrial fibrillation, the following flow pattern predicted aortic valve disease: 'pulsus tardus et parvus' in the CCA and ICA was highly predictive for a moderate-to-severe AS (OR 1158.5, 95% CI 364.2-3684.8, p < 0.001). 'No dicrotic notch' (OR 102.1, 95% CI 12.4-839.4, p < 0.001), a 'bisferious pulse' (OR 10.8, 95% CI 3.2-33.9, p < 0.001) and a 'diastolic reversal' (OR 15.4, 95% CI 3.2-74.6, p < 0.001) in the CCA and ICA predicted a moderate-to-severe AR. The inclusion of Doppler flow characteristics of the ECA did not increase predictive value. CONCLUSIONS: Well defined, qualitative Doppler flow characteristics detectable in the CCA and ICA are highly predictive for aortic valve disease. The consideration of these flow characteristics can be useful to streamline diagnostic and therapeutic measures, especially in the outpatient setting.
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Meyer et al. (2023) conducted a cohort in Ischemic stroke or transient ischemic attack (n=1,320). Doppler flow morphology characteristics (e.g., pulsus tardus et parvus) vs. Absence of specific Doppler flow characteristics was evaluated on Presence of moderate-to-severe aortic valve stenosis (OR 1158.5, 95% CI 364.2-3684.8, p=<0.001). The presence of 'pulsus tardus et parvus' in the common and internal carotid arteries was highly predictive of moderate-to-severe aortic valve stenosis (OR 1158.5).
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