Clinical clue of severe aortic stenosis. Simultaneous palpation of the carotid and apical impulses

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Abstract
In patients with severe aortic stenosis, simultaneous palpation of the carotid and apical impulses yields a palpable lag time between the 2. Apexcardiograms and carotid pulse tracings were recorded in 66 control subjects and in 30 patients with aortic stenosis. By using the QRS peak as reference, the peak appearance time of the carotid pulse tracings and apexcardiograms was measured, and the difference was calculated as a palpable lag time; 21/30 patients had a palpable lag time, whereas 9 did not; 22/30 patients with aortic stenosis had aortic valve areas of < 1 cm2. Of these 22 patients, 21 had a palpable lag time. The sensitivity of a palpable lag time for aortic valve areas of < 1 cm2 was 95%, specificity 100%, positive predictive value 100% and negative predictive value 89%. The group means for measured lag times between controls (70 .+-. 7 ms) and those patients with aortic stenosis (133 .+-. 7 ms) showed a definite difference. The palpable lag time by linear regression analysis has an r = 0.68, 3rd in rank to the aortic valve gradient and ECG for predicting aortic valve area. Multiple regression analysis found that the palpable lag time, ECG, syncope and shudder waves are together able to predict the aortic valve area (r = 0.85).

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