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Wave reflections

Clinical and therapeutic aspects
  • Gérard M. London
  • Toshio Yaginuma
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 144)

Abstract

Ejection of blood during contraction of the left ventricle generates a pressure wave which is propagated along the arterial tree and which is perceived in the peripheral arteries as the arterial pulse. As the pressure wave moves away from the heart, part of the energy is reflected back at various sites of the arterial tree. The forward and backward pressure waves merge to produce a characteristic arterial pressure wave [1–3] (Figure 1). The existence of wave reflections is demonstrated by at least two fundamental phenomena:
  • — the radically different shapes of flow and pressure waves in the ascending aorta, since in the absence of reflected waves the flow and pressure waves would be almost identical [1–3]; and

  • — the different pressure amplitudes and waveforms in the aorta and peripheral arteries, with an increased pulse amplitude along the arterial tree with systolic pressure usually higher and diastolic pressure lower in the peripheral arteries [1–3]. This peripheral amplification of pulse and systolic pressures contrasts with an almost constant mean blood pressure whose pressure drop between ascending aorta and radial artery does not exceed 3 mmHg[4, 5].

Keywords

Pulse Pressure Pulse Wave Velocity Pressure Wave Wave Reflection Arterial Tree 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Milnor WR. Hemodynamics, 2nd ed. Baltimore: Williams & Wilkins 1989: 204–259.Google Scholar
  2. 2.
    Nichols WW, O’Rourke MF. In: McDonald’s Blood Flow in Arteries: theoretic, experimental and clinical principles. 3rd ed. London; Edward Arnold 1991: 251–269; 281: 329.Google Scholar
  3. 3.
    O’Rourke MF. Arterial Function in Health and Disease. Edinburgh; Churchill Livingstone 1982: 177–182.Google Scholar
  4. 4.
    Kroeker EJ, Wood EH. Comparison of simultaneously recorded central and peripheral arterial pressure pulses during rest, exercise and tilted position in man. Circ Res 1955; 3: 623–632.PubMedCrossRefGoogle Scholar
  5. 5.
    O’Rourke MF, Kelly R, Avolio A. The arterial pulse in cardiovascular disease. In: The arterial pulse. Philadelphia; Lea & Febiger 1992: 121–197.Google Scholar
  6. 6.
    Kelly R, Hayward C, Avolio A, O’Rourke M. Noninvasive determination of Age-Related Changes in the Human Arterial Pulse. Circulation 1989; 80: 1652–1659.PubMedCrossRefGoogle Scholar
  7. 7.
    London GM, Guerin AP, Pannier B, Marchais SJ, Benetos A, Safar ME. Increased systolic pressure in chronic uremia: Role of arterial wave reflections. Hypertension 1992; 20: 10–19.PubMedCrossRefGoogle Scholar
  8. 8.
    Burattini R, Knowlen GG, Campbell KB. Two arterial effective reflecting sites may appear as one to the heart. Circ Res 1991; 68: 85–99.PubMedCrossRefGoogle Scholar
  9. 9.
    O’Rourke MF, Yaginuma T. Wave Reflections and the Arterial Pulse. Arch Intern Med 1984; 144: 366–371.PubMedCrossRefGoogle Scholar
  10. 10.
    Latham RD, Westerhof N, Sipkema P, Rubal BJ, Reuderink P, Murgo JP. Regional wave travel and reflection along the human aorta: a study with six simultaneous micromanometric pressures. Circulation 1985; 72: 1257–1269.PubMedCrossRefGoogle Scholar
  11. 11.
    Murgo JP, Westerhof N, Giolma JP, Altobelli SA. Aortic Input Impedance in Normal Man: Relationship to Pressure Wave Forms. Circulation 1980; 62: 105–116.PubMedCrossRefGoogle Scholar
  12. 12.
    Kelly R, Daley J, Avolio A, O’Rourke M. Arterial Dilation and Reduced Wave Reflection: Benefit of Dilevalol in Hypertension. Hypertension 1989; 14: 14–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Fitchett H. LV-arterial coupling: interactive model to predict effect of wave reflections on LV energetics. Am J Physiol (Heart Circ. Physiol. 30); 1991; 261: H1026–H1033.Google Scholar
  14. 14.
    Laskey WK, Kussmaul WG. Arterial wave reflection in heart failure. Circulation 1987; 75: 711–722.PubMedCrossRefGoogle Scholar
  15. 15.
    Nichols WW, O’Rourke MF, Avolio AP, Yaginuma T, Pepine CJ, Onti R. Ventricular/vascular interaction in patients with mild systemic hypertension and normal peripheral resistance. Circulation 1986; 74: 455–462.PubMedCrossRefGoogle Scholar
  16. 16.
    Murgo JP, Westerhof N, Giolma JP, Altobelli SA. Manipulation of ascending aortic pressure and flow wave reflections with the Valsalva maneuver: relationship to input impedance. Circulation 1981; 63: 122–132.PubMedCrossRefGoogle Scholar
  17. 17.
    Kelly R, Hayward C, Ganis J, Daley J, Avolio A, O’Rourke M. Noninvasive Registration of the Arterial Pressure Pulse Wave form Using High-Fidelity Applanation Tonometry. J Vasc Med Biol 1989; 1: 142–149.Google Scholar
  18. 18.
    Avolio AO, Chen SG, Wang RP, Zhang Cl, Li MF, O’Rourke MF. Effects of Aging on Changing Arterial Compliance and Left Ventricular Load in a Northern Chinese Urban Community. Circulation 1983; 68: 50–58.PubMedCrossRefGoogle Scholar
  19. 19.
    Avolio AP, Deng FQ, Li WQ, Luo YF, Huang ZD, Xing LF, O’Rourke MF. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation 1985; 71: 202–210.PubMedCrossRefGoogle Scholar
  20. 20.
    Greenwald SE, Carter AC, Berry CL. Effect of Age on the In Vitro Reflection Coefficient of the Aorto-iliac Bifurcation in Humans. Circulation 1990; 82: 114–123.PubMedCrossRefGoogle Scholar
  21. 21.
    London GM, Marchais SJ, Safar ME, et al. Aortic and large artery compliance in end-stage renal failure. Kidney Int 1990; 37: 137–142.PubMedCrossRefGoogle Scholar
  22. 22.
    Gow BS, O’Rourke MF. Comparison of pressure and flow in the ascending aorta of different mammals. Proceedings, Australian Physiol and Pharmacol Soc 1970: 1–68.Google Scholar
  23. 23.
    Avolio AP, O’Rourke MF, Mang K, Bason PT, Gow BS. A comparative study of arterial pulsatile hemodynamics in rabbits and guinea pigs. Am J Physiol 1976; 230: 868–875.PubMedGoogle Scholar
  24. 24.
    London GM, Guerin AP, Pannier BM, Marchais SJ, Metivier F. Body height as a determinant of carotid pulse contour in humans. J Hypertens 1992; 10(Suppl 6): S93–S95.Google Scholar
  25. 25.
    Milnor WR. Aortic wavelength as a determinant of the relation between body size and heart rate in mammals. Am J Physiol 1979; 237: R3–R6.PubMedGoogle Scholar
  26. 26.
    O’Rourke MF. Commentary on aortic wavelength as a determinant of the relationship between heart rate and body size in mammals. Am J Physiol 1981; 240: R393–R395.PubMedGoogle Scholar
  27. 27.
    Kannel WB, Dawber TR, McGee DL. Perspectives on systolic hypertension: The Fram-ingham Study. Circulation 1980; 61: 1179–1182.PubMedCrossRefGoogle Scholar
  28. 28.
    Curb JD, Borhani NO, Entwisle G, et al. Isolated systolic hypertension in 14 communities. Am J Epidemiol 1985; 121: 362–370.PubMedCrossRefGoogle Scholar
  29. 29.
    SHEP cooperative research group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the systolic hypertension in the elderly program. J Am Med Assoc 1991; 265: 3255–3264.CrossRefGoogle Scholar
  30. 30.
    Hajdu MA, Heistad DD, Baumbach GL. Effects of antihypertensive treatment on mechanics of cerebral arterioles in rats. Hypertension 1990; 17: 308–316.CrossRefGoogle Scholar
  31. 31.
    Baumbach GL, Siems JE, Heistad DD. Effects of local reduction in pressure on distensibility and composition of cerebral arterioles. Circ Res 1991; 68: 338–351.PubMedCrossRefGoogle Scholar
  32. 32.
    Christensen KL. Reducing pulse pressure in hypertension may normalize small artery structure. Hypertension 1990; 18: 722–727.CrossRefGoogle Scholar
  33. 33.
    Darne B, Girerd X, Safar M, Cambien F, Guize L. Pulsatile versus steady component of Blood pressure: A cross-sectional and prospective Analysis of cardiovascular mortality. Hypertension 1989; 13: 392–400.PubMedCrossRefGoogle Scholar
  34. 34.
    Simon P, Ang KS, Benziane A. Hypertension arterielle systolique isolé e chez l’uré mique chronique hé modialysé. Arch Mal Coeur 1991; 84: 1205–1210.PubMedGoogle Scholar
  35. 35.
    London GM, Fabiani F. Left ventricular dysfunction in end-stage renal disease: echocardio-graphic insights. In: Parfrey PS, Harnett JD, editors. Cardiac dysfunction in chronic uremia. Boston: Kluwer Academic 1992: 117–137.CrossRefGoogle Scholar
  36. 36.
    Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 1974; 290: 697–701.PubMedCrossRefGoogle Scholar
  37. 37.
    London GM, Guerin AP, Pannier BM, Marchais SJ, Metivier F, Safar ME. Relation of left ventricular mass to arterial wave reflections in chronic uremia. Hypertension 1993; (in press).Google Scholar
  38. 38.
    Hiiting J, Kramer W, Schutterle G, Wizemann V. Analysis of left-ventricular changes associated with chronic hemodialysis. A non-invasive follow-up study. Nephron 1988; 49: 284–290.CrossRefGoogle Scholar
  39. 39.
    Harnett JD, Parfrey PS, Griffiths SM, Gault MH, Barre P, Guttmann RD. Left ventricular hypertrophy in end-stage renal disease. Nephron 1988; 48: 107–205.PubMedCrossRefGoogle Scholar
  40. 40.
    Yaginuma T, Avolio AP, O’Rourke M, et al. Effect of glyceryl trinitrate on peripheral arteries alters left ventricular hydraulic load in man. Cardiovasc Res 1986; 20: 153–160.PubMedCrossRefGoogle Scholar
  41. 41.
    Fitchett D, Simkus G, Genest J, Beaudry J, Marpole D. Reflected pressure waves in the ascending aorta: effect of glyceryl trinitrate. Cardiovasc Res 1988; 22: 494–500.PubMedCrossRefGoogle Scholar
  42. 42.
    Simkus GJ, Fitchett DH. Radial artery pressure measurements may be a poor guide to the beneficial effects of nitroprusside on left ventricular systolic pressure in congestive heart failure. Am J Cardiol 1990; 66: 323–326.PubMedCrossRefGoogle Scholar
  43. 43.
    Kelly R, Gibbs H, O’Rourke M, et al. Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery. Eur Heart J 1990; 11: 138–144.PubMedGoogle Scholar
  44. 44.
    Guerin AP, Pannier BM, Marchais SJ, Metivier F, Safar ME, London GM. Effects of antihypertensive agents on carotid pulse contour in humans. J of Human Hypertension 1992; 6 (Suppl 2): S37–S40.Google Scholar
  45. 45.
    Fujii M, Yaginuma T, et al. Non invasive detection for wave reflection in the arterial system, by using carotid pulse wave, and its clinical implication. J Coll Angio 1989; 29: 545–551.Google Scholar
  46. 46.
    Ting CT, Chou CY, Chang MS, Wang SP, Chiang BN, Yin FCP. Arterial hemodynamics in human hypertension. Effects of adrenergic blockade. Circulation 1991; 84: 1049–1057.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1993

Authors and Affiliations

  • Gérard M. London
  • Toshio Yaginuma

There are no affiliations available

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