Duplex Sonography of the Carotid Arteries in Patients with Pure Aortic Regurgitation: Pulse Waveform and Hemodynamic Changes and a New Indicator of the Severity of Aortic Regurgitation

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Abstract

Purpose

To determine the changes of multiple hemodynamic parameters and pulse wave contour in pure aortic regurgitation (AR) and to present a new indicator of the severity of AR (shrink ratio of proximal common carotid artery).

Material and Methods

The sonograms of 42 patients (31 M, 11 F; 16–68 years) with pure AR and 18 control subjects (15 M, 3 F; 20–47 years) were assessed for velocities and indices, and change of pulse wave contour (bisferious pattern, zero level and retrograde diastolic flow) in each carotid artery. Shrink ratio (maximum diameter–minimum diameter/maximum diameter) of each proximal common carotid artery was calculated.

Results

Bisferious waveforms seen in patients with AR grade 1, grade 2, and grade 3–4 were 66%, 83%, and 88%, respectively. Diastolic reversed flow was determined in 7 (39%) of 18 patients with AR grade 3–4. Three patients (25%) with AR grade 2 and 4 patients (22%) with AR grade 3–4 had zero level diastolic flow in the common carotid artery. Statistically significant changes of decreased end-diastolic velocity, increased peak systolic velocity/end-diastolic velocity, resistivity index, and pulsatility index were revealed, especially in AR grade 3–4 compared to controls. Significantly increased shrink ratio was seen only in AR grade 3–4.

Conclusion

Increased shrink ratio or changes in hemodynamics or pulse waveform can be used in recognition of AR.

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