Severity of Aortic Stenosis Assessed by Carotid Pulse Recordings and Phonocardiography

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Abstract
The external carotid pulse, phonocardiogram (PCG) and ECG were studied in 26 adult patients with valvular aortic stenosis whose systolic peak pressure gradients ranged from 18-165 mmHg. A significant correlation was found between rapidity of the pulse upstroke, as measured by the T-time, and the location of the peak of the systolic murmur during ventricular ejection and gradient. The left ventricular ejection time (LVET) related directly and the pre-ejection period (PEP) indirectly with the gradient. A significant inverse relationship occurred between the PEP/LVET quotient and the pressure gradient but this quotient did not classify patients by the severity of the stenosis, T-time or location of the peak of murmur. When a combination of T-time, PEP/LVET and location of the peak of murmur was used in each patient, a good discrimination between patients was achieved. When the pressure gradient was above 50 mmHg, at least 1 measurement was abnormal and, when it exceeded 100 mmHg, at least 2 measurements were abnormal. It is possible to separate patients with valvular aortic stenosis from those with hypertrophic obstructive cardiomyopathy (idiopathic hypertrophic subaortic stenosis) or mitral insufficiency on the basis of carotid pulse tracings and PCG.