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2.5 Does Wave Reflection Protect the Microvasculature from High Pulse Pressure?
Artery Research volume 24, pages 70–71 (2018)
Abstract
Background
Wave reflection (caused by a stiffness increase from large to small arteries) has been considered to protect against high microvasculature Pulse Pressures (mPP) (1). However, according to transmission line theory, Transmission (T) and Reflection (R) coefficients are proportional (T = 1+R), implying that reflection would not be protective. Proximal arterial stiffening with aging is associated with reduced Total Arterial Compliance (TAC) and increased forward Pressure (Pfw). We hypothesized that a high TAC and low Pfw, rather than high R, are responsible for protection from mPP.
Methods
We constructed a fractal arterial tree containing 5008 vessels across 14 generations (fractal exponent 2.76, asymmetry ratio 0.8). Wave speed in each vessel was prescribed to achieve a uniform reflection coefficient (R = −0.025, 0, 0.025 or 0.05) at every junction, achieved by progressively stiffening distal vessels while keeping aortic wave speed constant (“distal-stiffening”) or by progressively stiffening proximal vessels while keeping average wave speed in all terminal vessels constant (“proximal-stiffening”, see Figure). An elastance heart model was applied at the inlet and simulations were performed with a one-dimensional flow solver (2).
Results
Proximal-stiffening and distal-stiffening had opposing effects on R but the same effects on mPP, whereas mPP increased monotonically with decreasing TAC and increasing Pfw in both settings (Figure).
Conclusion
Wave reflection per se does not provide protection from high mPP since greater reflection also entails greater transmitted pressure. Although a decreased R may accompany proximal arterial stiffening, the likely mechanism of increased mPP with aging is decreased TAC and greater Pfw.
References
Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol. 2008;105(5):1652–60.
Mynard JP, Smolich JJ. One-Dimensional Haemodynamic Modeling and Wave Dynamics in the Entire Adult Circulation. Ann Biomed Eng. 2015;43(6):1443–60.
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Kondiboyina, A., Smolich, J., Cheung, M. et al. 2.5 Does Wave Reflection Protect the Microvasculature from High Pulse Pressure?. Artery Res 24, 70–71 (2018). https://doi.org/10.1016/j.artres.2018.10.028
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DOI: https://doi.org/10.1016/j.artres.2018.10.028