Écho-Doppler artériel et sténose valvulaire aortique: étude de la sensibilité et de la spécificité des signes

Abstract

Purposes In this prospective study, we sought to determine the sensitivity and the specificity of arterial Doppler findings of valvular aortic stenosis (VAS). Patients and Methods 20 control subjects and 20 patients with various degrees of VAS underwent Doppler ultrasound of the carotids, abdominal aorta, renal arteries and limb arteries. We analyzed and compared the shape of the spectral profiles, peak systolic velocity (PSV), systolic upstroke time (SUT) and systolic upstroke index (SUI) of every tracing. The protodiastolic notch (PDN) of the common femoral arteries were recorded too. Results VAS hardly modifies the overall shape of the Doppler spectrums of the aorta or limb arteries but it implies a biphasic deformation or a doubling of the systolic peak of the neck vessels. We also encountered biphasic profiles in renal arteries of patients with tight VAS. The PSV, SUI and depth of the PDN tend to diminish in cases of VAS but the variations are inconstant and rarely proportional to the severity of the narrowing. The increase of the SUT, on the contrary, is linearly correlated to the severity of the stenosis in every arterial system: SUTs in the common carotid artery, internal carotid artery or brachial artery that are shorter than or equal to 70 milliseconds (msec) are the obvious marks of the absence of VAS. It was not possible to differentiate between the intermediate stenoses (aortic valve area between 0.8 and 2 square centimeters) whereas critical aortic stenoses, whose area is less than or equal to 0.7 square centimeter, can be detected by the presence of at least two of the four following criteria of SUT: equal to or above 180 msec for the common carotid, 200 msec for the internal carotid, 130 msec for the aorta and 110 msec for the common femoral artery. Conclusion During routine arterial Doppler ultrasound, a precise analysis of the spectrums and some SUT measurements allow he assessment of the aortic valve.