Extracranial Doppler ultrasound showed aortic regurgitation had reduced end-diastolic velocity (p<0.001), while aortic stenosis had parvus-tardus waveforms (69% vs 8%, p<0.001) compared to controls.
Case-Control (n=200)
Does extracranial Doppler ultrasound identify specific hemodynamic patterns associated with moderate-to-severe cardiac valvulopathies compared to controls?
Specific extracranial Doppler ultrasound patterns, such as parvus-tardus waveforms for stenosis and biphasic morphology for regurgitation, can suggest the presence of significant cardiac valvular disease during routine stroke assessment.
p-value: p=<0.001
Abstract Background and aims Extracranial Doppler ultrasound (EDU) is widely used in stroke assessment, but whether carotid flow patterns reflect cardiac valvular disease is not established We aimed to identify Doppler hemodynamic patterns associated with valvulopathies and related markers. Methods Retrospective study of consecutive patients undergoing EDU with transthoracic echocardiography. Patients with moderate-to-severe aortic or mitral stenosis or regurgitation were compared with controls without known valvular disease, matched for age, sex, and hypertension. Doppler parameters (end-diastolic-velocity EDV, resistance index RI, acceleration-time AT, and waveform morphology) were analysed in the common (CCA) and internal carotid arteries (ICA). Results We included 100 patients with valvular disease (35 aortic stenosis, 25 aortic regurgitation, 25 mitral regurgitation, 15 mitral stenosis) and 100 controls. Compared with controls, aortic regurgitation was associated with reduced EDV and increased RI in both CCA (5.6 vs 12.3cm's; 0.92 vs 0.78) and ICA (8.4 vs 17.9cm's; 0.85 vs 0.69; p0.001). Biphasic waveforms (34% vs 0%) and shorter AT were more frequent in regurgitation (p0.001). Aortic stenosis showed lower ICA-EDV, parvus–tardus waveforms (69% vs 8%) and prolonged AT (p0.001). Regurgitations lesions demonstrated lower EDV (p0.001) and higher RI (p=0.007) than stenotic. In stenosis, smaller valve area and lower ejection-fraction correlated with higher ICA-RI (p=0.031; p0.001); in regurgitations, ejection-fraction correlated inversely with CCA-AT (p=0.044), and left atrial size correlated with RI (p=0.018). Conclusions Recognising low-EDV/high-RI with shorter-AT and biphasic morphology as suggestive of regurgitation and prolonged AT with parvus–tardus pattern as suggestive of stenosis, may help raise suspicion of relevant valvular disease during routine stroke assessment. Conflict of interest All authors: Nothing to disclose
Lopes et al. (2026) conducted a case-control in Cardiac valvulopathies (n=200). Extracranial Doppler ultrasound vs. Controls without known valvular disease was evaluated on Doppler parameters (EDV, RI, AT, and waveform morphology) in the common and internal carotid arteries (p=<0.001). Extracranial Doppler ultrasound showed aortic regurgitation had reduced end-diastolic velocity (p<0.001), while aortic stenosis had parvus-tardus waveforms (69% vs 8%, p<0.001) compared to controls.