Usefulness of clinical assessment of the carotid pulse in the diagnosis of aortic stenosis.

In a prospective controlled study, we compared the blinded assessment of the carotid pulse (independent of other clinical signs) by 1 of 3 cardiologists with applanation tonometry on the radial and carotid pulse (time to dominant peak and maximum rate of rise [-dP/dt]). We studied 23 patients with significant isolated aortic stenosis (AS) and 23 control patients. The odds ratio of finding a slowly rising pulse, representing AS, compared with a finding of a "normal"/"indeterminate" pulse was 10.4. Radial dP/dt was significantly lower in the group with AS, whereas carotid dP/dt was not significantly different between the 2 groups.