PULSATILE LOWER-LIMB VENOUS DOPPLER FLOW - PREVALENCE AND VALUE IN CARDIAC DISEASE DIAGNOSIS

The purpose of this study was to assess the frequency and significance of pulsatile Doppler waveforms in lower limb veins. We used Doppler s onographic data from the common femoral vein. In the first of two grou ps, the findings in 250 patients were correlated with the presence of cardiac decompensation on concurrent chest radiographs. In the second group, the findings in 81 patients were correlated with the presence o f tricuspid regurgitation on Doppler echocardiograms. A venous Doppler sonographic examination was considered normal if spontaneous anterogr ade phasic flow was present and pulsatile if flow had a cyclic retrogr ade component. In group 1, 21% had pulsatile waveforms whereas 24% had cardiac decompensation. In group 2, 36% had pulsatile waveforms and 4 3% had tricuspid regurgitation. A statistically significant correlatio n was found between the presence of these abnormal waveforms and cardi ac decompensation or tricuspid regurgitation, with sensitivities of 57 % and 54%, specificities of 91% and 78%, positive predictive values of 66% and 66%, negative predictive values of 87% and 69%, and accuracie s of 82% and 68%, respectively. In a subgroup of 55 patients who had b oth tests for correlation and in whom both were in agreement, the sens itivity of venous Doppler sonographic examination for detecting pathol ogic cardiac conditions was 79%, specificity was 87%, positive predict ive value was 83%, negative predictive value was 84%, and accuracy was 84%. IN 77 patients with pulsatile waveforms, including 24 without co ncurrent chest radiographs or echocardiograms, 63 (82%) had no prior h istory of cardiac disease. When correlated separately with chest radio graph or Doppler echocardiography, the test is not very sensitive in t he diagnosis of cardiac disease; however, when both correlating tests are performed and are in agreement, all diagnostic parameters of the v enous Doppler sonographic test, including sensitivity, become fairly h igh. The presence of pulsatile lower limb venous Doppler flow should a lert the sonologist that a pathologic cardiac condition may be the cul prit, especially in patients who have no such prior diagnosis.