title: Usefulness of peripheral arterial signs in the evaluation of aortic regurgitation.
abstract: Early diagnosis and optimal timing of surgical repair for chronic aortic regurgitation (AR) are topics of interest, because left ventricular compensation delays the clinical signs of the early stages of left ventricular dysfunction. Various physical signs have been described as indicators of chronic AR, but AR screening can be difficult depending on the proficiency of primary care providers. The recent use of the cardio-ankle vascular index (CAVI) measurement to assess peripheral atherosclerosis may detect AR objectively and simply because its arterial pulse wave configuration is closely related to the physical signs of AR.
  
  
  
  CAVI measurements include pulse pressure (PP), the difference in blood pressures between upper and lower limbs (ABD), ankle-brachial index (ABI), ejection time (ET), and upstroke time (UT). We evaluated the differences in CAVI parameters between AR group and age-matched control group, the relationships between CAVI parameters and the echocardiographic semi-quantitative measurements of AR severity such as left ventricular dimensions (Dd, Ds) and vena contracta (VC), and between the changes in CAVI parameters before and after aortic valve replacement.
  
  
  
  ABD, PP, ET, ankle systolic pressure and ABI in the AR group were significantly higher than that in the control group. Brachial diastolic pressure and CAVI in the AR group were significantly lower than that in the control group. UT was lower than that in the control group (p=0.05). PP did not correlate with the semi-quantitative AR severity, but ABD was correlated with Dd, Ds, and VC and was negatively correlated with UT. The exaggerated ABD, PP, ET, and ABI were moderated after surgery.
  
  
  
  CAVI parameters could be useful in the screening and serial follow-up of AR patients.
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: siraisih@koto.kpu-m.ac.jp.
authors: Hirokazu
authors: H
authors: Shiraishi
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Takeshi
authors: T
authors: Shirayama
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Naoki
authors: N
authors: Maruyama
authors: Saiseikai Shigaken Hospital, Shiga, Japan.
authors: Satoshi
authors: S
authors: Kaimoto
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Asako
authors: A
authors: Otakara
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Ritsuko
authors: R
authors: Kurimoto
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Naohiko
authors: N
authors: Nakanishi
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Takeshi
authors: T
authors: Nakamura
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Tetsuhiro
authors: T
authors: Yamano
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Akiyoshi
authors: A
authors: Matsumuro
authors: Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Kiyoshi
authors: K
authors: Doi
authors: Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Hitoshi
authors: H
authors: Yaku
authors: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Satoaki
authors: S
authors: Matoba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D013318:Stroke Volume / Q000502:physiology*; D034941:Upper Extremity / Q000098:blood supply; D055815:Young Adult
keywords: Aortic regurgitation; Cardio-ankle vascular index; Echocardiography; Hill's sign