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Published on: November 28, 2018
Association of common carotid artery Doppler-determined dicrotic notch velocity with the left ventricular ejection
Joseph F Polak1, Jean M Alessi-Chinetti2, Ayan R Patel2
1Departments of Radiology (J.F.P.) and Vascular Surgery (J.M.A.-C., J.M.E.) and Division of Cardiology/Cardiovascular Center (J.M.A.-C., A.R.P.), Tufts Medical Center, Boston, Massachusetts USA. jpolak@tuftsmedicalcenter.org.
Insights
The dicrotic notch velocity in common carotid artery Doppler waveforms is linked to left ventricular ejection fraction (LVEF). This finding may offer clinical value for assessing cardiac function non-invasively.
Area of Science:
- Cardiovascular Physiology
- Diagnostic Imaging
- Hemodynamics
Background:
- The dicrotic notch on blood pressure tracings indicates impaired cardiac function.
- Common carotid artery (CCA) waveforms possess similar markers but lack established links to cardiac function.
Purpose of the Study:
- To investigate the association between CCA dicrotic notch velocities and left ventricular ejection fraction (LVEF) assessed by echocardiography.
Main Methods:
- Retrospective analysis of 37 patients with concurrent echocardiography and carotid Doppler evaluations.
- LVEF determined using the biplane modified Simpson rule.
- CCA Doppler parameters, including dicrotic notch velocity, were measured and analyzed using linear and multivariable regression models.
Main Results:
- CCA dicrotic notch velocity was significantly associated with LVEF in bivariate analysis (P = .028).
- Multivariable regression identified dicrotic notch velocity (P = .001) and resistive index (P = .01) as significant predictors of LVEF.
- The predictive model achieved an R-squared of 0.37 (P = .004).
Conclusions:
- CCA dicrotic notch velocities correlate with LVEF.
- These Doppler-derived velocities may hold clinical utility in specific patient populations for cardiac function assessment.
Objectives:
The appearance of the dicrotic notch on blood pressure tracings is associated with impaired cardiac function. Common carotid artery waveforms have similar fiduciary markers, yet they have not been related to cardiac function. We studied associations of common carotid artery dicrotic notch velocities with the left ventricular ejection fraction (LVEF) determined by echocardiography.
Methods:
We conducted a retrospective study of 37 patients who had cardiac echocardiography and carotid Doppler evaluations within 1 day of each other. The LVEF was determined by the biplane modified Simpson rule. Doppler parameters were measured from tracings of the left common carotid artery 4 cm from the flow divider. Linear regression and stepwise multivariable linear regression models were used to evaluate any association between the LVEF and the following variables: age, sex, peak systolic velocity (PSV), end-diastolic velocity (EDV), dicrotic notch velocity, rise time (EDV to PSV), resistive index, and cardiac cycle length.
Results:
The dicrotic notch velocity was the only variable associated with the LVEF (P = .028) in a bivariate analyses. A backward selection stepwise multivariable equation predicting the LVEF had the dicrotic notch (P = .001) and resistive index (P = .01) as significant predictors, whereas the cardiac cycle length (P = .08) and PSV (P = .08) were borderline not significant. Model goodness of fit was R(2) = 0.37 (P = .004).
Conclusions:
Dicrotic notch velocities measured from common carotid artery Doppler waveforms are associated with the LVEF and might offer some clinical value in selected cases.
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