Assessment of the severity of aortic stenosis from the carotid pulse tracing.

Abstract

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.