Manifestations of Cardiac Disease in Carotid Duplex Ultrasound Examination

Madhwal, Surabhi; Yesenko, Sandra; Kim, Esther Soo Hyun; Park, Margaret; Begelman, Susan M.; Gornik, Heather L.

doi:10.1016/j.jcmg.2013.09.015

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…In the evaluated cohort of patients with TIA and ischemic stroke without occlusions or stenosis of the carotid vessels, doppler flow characteristics in the ICA and CCA were found to be highly predictive for aortic valve disease. This is in line with previous trials [ 7 , 16 ] evaluating the effect of aortic valve pathologies on Doppler flow spectrums in nvUS. In contrast to prior studies, in this trial a larger number of patients were included, assessing the translatability of small cohort findings onto a larger scale.…”

Section: Discussionsupporting

confidence: 92%

Doppler flow morphology characteristics of epiaortic arteries in aortic valve pathologies: a retrospective study on a cohort of patients with ischemic stroke

Meyer¹,

Wilde²,

Wolf

et al. 2023

Ultrasound J

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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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Section: Discussionsupporting

confidence: 92%

Doppler flow morphology characteristics of epiaortic arteries in aortic valve pathologies: a retrospective study on a cohort of patients with ischemic stroke

Meyer¹,

Wilde²,

Wolf

et al. 2023

Ultrasound J

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“…Valvular diseases are known to affect carotid tracings, which may render the dicrotic notch more difficult to appreciate [40–42]. Indeed, in our study, self-report ease of measuring cycle time was higher than for systole time, which may be a reflection of the difficulty in identifying the dicrotic notch in certain cases.…”

Section: Discussionmentioning

confidence: 59%

Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements

et al. 2017

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BackgroundNon-invasive measures that can accurately estimate cardiac output may help identify volume-responsive patients. This study seeks to compare two non-invasive measures (corrected carotid flow time and carotid blood flow) and their correlations with invasive reference measurements of cardiac output. Consenting adult patients (n = 51) at Massachusetts General Hospital cardiac catheterization laboratory undergoing right heart catheterization between February and April 2016 were included. Carotid ultrasound images were obtained concurrently with cardiac output measurements, obtained by the thermodilution method in the absence of severe tricuspid regurgitation and by the Fick oxygen method otherwise. Corrected carotid flow time was calculated as systole time/√cycle time. Carotid blood flow was calculated as π × (carotid diameter)2/4 × velocity time integral × heart rate. Measurements were obtained using a single carotid waveform and an average of three carotid waveforms for both measures.ResultsSingle waveform measurements of corrected flow time did not correlate with cardiac output (ρ = 0.25, 95% CI −0.03 to 0.49, p = 0.08), but an average of three waveforms correlated significantly, although weakly (ρ = 0.29, 95% CI 0.02–0.53, p = 0.046). Carotid blood flow measurements correlated moderately with cardiac output regardless of if single waveform or an average of three waveforms were used: ρ = 0.44, 95% CI 0.18–0.63, p = 0.004, and ρ = 0.41, 95% CI 0.16–0.62, p = 0.004, respectively.ConclusionsCarotid blood flow may be a better marker of cardiac output and less subject to measurements issues than corrected carotid flow time.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-017-0065-0) contains supplementary material, which is available to authorized users.

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“…Severe aortic stenosis or regurgitation and hypertrophic cardiomyopathy my significantly change the doppler waveforms 16 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic criteria for the determination of clinically significant internal carotid artery stenosis using duplex ultrasound

Gorican¹,

Chochola²,

Kocik³

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Carotid endarterectomy is beneficial in symptomatic patients with ≥70% stenosis at the bifurcation of the internal carotid artery. The fact that the duplex ultrasound is widely used, inexpensive and non-invasive for examination of the carotid arteries underlines the importance of high accuracy of this method for grading internal artery stenosis. Patients and Methods. Duplex scans and arteriograms of carotid arteries of 142 patients were reviewed. Peak and end-diastolic velocities of the common and internal carotid arteries were recorded, and the percent stenosis of the internal carotid artery was determined by arteriogram. Receiver-operator characteristic curves of sensitivity, specificity, positive and negative predictive values and accuracy were determined. Results. The recommended criteria for the detection of ≥70% stenosis of the internal carotid artery were: peak systolic velocity in the internal carotid artery ≥215 cm/s, end-diastolic velocity in the internal carotid artery ≥65 cm/s, ratio of peak systolic velocities in the internal and common carotid arteries ≥2.7 and ratio of the end-diastolic velocities of the internal and common carotid arteries ≥3.7. Conclusion. These criteria allow for reliable determination of internal carotid artery stenosis ≥70% by duplex ultrasound.

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Manifestations of Cardiac Disease in Carotid Duplex Ultrasound Examination

Cited by 5 publications

References 2 publications

Doppler flow morphology characteristics of epiaortic arteries in aortic valve pathologies: a retrospective study on a cohort of patients with ischemic stroke

Doppler flow morphology characteristics of epiaortic arteries in aortic valve pathologies: a retrospective study on a cohort of patients with ischemic stroke

Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements

Diagnostic criteria for the determination of clinically significant internal carotid artery stenosis using duplex ultrasound

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