Cited by 279Cardiovascular Health and Disease PreventionCardiovascular Function and Risk FactorsHemodynamic Monitoring and Therapy

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Wave reflection in the systemic circulation and its implications in ventricular function

O??Rourke, Michael F., Kelly, Raymond P.·1993·Journal of Hypertension

DOI 10.1097/00004872-199304000-00001

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From the Medical Professorial Unit, St Vincent's Hospital, Darlinghurst, New South Wales, Australia

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Crossref · 10.1097/00004872-199304000-00001

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“Observed changes in pressure and input impedance have been ascribed to altered 1) total arterial compliance [38], [39], 2) pulse wave velocity [21], [40]–[44], 3) site of reflection [ 43 ], [45], [46], and 4) magnitude of reflection [40], [41], [46]–[48].”
Background
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Arterial wave reflection is associated with severity of extracoronary atherosclerosis in patients with coronary artery disease
Lekakis, J. P., Ikonomidis, I., Protogerou, A. D., Papaioannou, T., Stamatelopoulos, K. S., Papamichael, C. M., & Mavrikakis, M. (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000198446.18989.4f · Cited by 34
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“Increasing stiffness of the entire aortic system predominantly burdens the proximal part of the aorta due to arterial wave reflections arriving back in the thoracic aorta earlier, ie, during late systole instead of early diastole, thereby adding to the pressure (and thus wall stress) in this aortic segment (29).”
Background
Age dependency of peripheral and central systolic blood pressures: cross-sectional and longitudinal observations in a Chinese population
Li, Y., Staessen, J. A., Sheng, C., Huang, Q., O’Rourke, M. F., & Wang, J. (2011) · Hypertension Research · doi:10.1038/hr.2011.160 · Cited by 32
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Association Between Invasively Measured Central Aortic Pressure and Left Ventricular Diastolic Function in Patients Undergoing Coronary Angiography
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“The early return of the pressure wave indicates increased central systolic pressure and decreased central diastolic pressure (9).”
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Is there a preferred antihypertensive therapy for isolated systolic hypertension and reduced arterial compliance?
Franklin, S. S. (2000) · Current Hypertension Reports · doi:10.1007/s11906-000-0008-0 · Cited by 31
“Second, vasodilation of small arteries will shorten the artery reflection sites, decrease early wave reflection, decrease aortic late SBP peaking, and hence decrease cardiac afterload [ 46 ].”
Background
Wave intensity amplification and attenuation in non-linear flow: Implications for the calculation of local reflection coefficients
Mynard, J. P., Penny, D. J., & Smolich, J. J. (2008) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2008.10.002 · Cited by 30
“…generated during ventricular systole are partially reflected from the vasculature and that these reflections make a significant contribution to ventricular afterload and overall haemodynamics (Brin and Yin, 1984; O’Rourke and Kelly, 1993; Duan and Zamir, 1995; Koh et al., 1998; Penny et al., 2008).”
TOWARDS OPTIMIZATION OF WAVE REFLECTION: THERAPEUTIC GOAL FOR TOMORROW?
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“5 This in turn leads to an increase in cardiac workload, predisposing to myocardial ischaemia and left ventricular hypertrophy”
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“…the characteristic peaks found in peripheral artery waveforms, including the pulse pressure (P-wave) and late systolic augmentation (D-wave), as displayed in Figure 10g, which encompass vital biomedical and physiological information that is crucial for diagnosing cardiovascular diseases [116,117].”
Background
Wave Propagation in Coupled Left Ventricle–Arterial System
Berger, D. S., Robinson, K. A., & Shroff, S. G. (1996) · Hypertension · doi:10.1161/01.hyp.27.5.1079 · Cited by 25
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“Most of the effects of drugs such as nitrates, calcium blockers, angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists which dilate the medium sized peripheral muscular arteries and the smaller arteries (6,13-16) reduce wave reflection.”
Background
Ventricular–vascular coupling in hypertension
Saba, P. S., Cameli, M., Casalnuovo, G., Ciccone, M. M., Ganau, A., Maiello, M. R., Modesti, P. A., Muiesan, M. L., Novo, S., Palmiero, P., et al. (2014) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000000146 · Cited by 25
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“The forward-going pressure wave is reflected back from sites of impedance mismatch and normally returns to the aorta during diastole, where it serves to maintain coronary artery blood flow [ 17 ].”
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Aspirin Alters Arterial Function in Patients with Chronic Heart Failure Treated with ACE Inhibitors: A Dose-Mediated Deleterious Effect
Meune, C., Mahé, I., Mourad, J., Solal, A. C., Levy, B. I., Kévorkian, J.-P., Jondeau, G., Habib, A., Lebret, M., Knellwolf, A., et al. (2003) · European Journal of Heart Failure · doi:10.1016/s1388-9842(03)00006-0 · Cited by 25
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“In addition, the importance of the aorta’s role in the pathogenesis of systolic hypertension has been recognized [69,70].”
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Background
Transcatheter aortic valve replacement (TAVR) leads to an increase in the subendocardial viability ratio assessed by pulse wave analysis
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Arterial Compliance
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“The PWV values are calculated based on the extraction of foot-to-foot transit time, which is determined by the time difference between the upstroke points of two pulse waves obtained at two different sites [11,12].”
Method
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“While these data attribute ESP artifact to contact of the catheter with the endocardium that can be easily eliminated, there are certain pathophysiological conditions that can also lead to legitimate, non-artifactual rises in ESP from reflected pressure waves [25, 26].”
Background
Increased arterial wave reflection may predispose syncopal attacks
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“Functionally, the endothelium is a large autocrine, paracrine, and endocrine organ that plays a key role in vascular homeostasis [34].”
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Arterial Wave Reflections Are Associated With Left Ventricular Diastolic Dysfunction in Adamantiades-Behçet's Disease
Ikonomidis, I., Aznaouridis, K., Protogerou, A. D., Stamatelopoulos, K. S., Markomihelakis, N., Papamichael, C. M., Kaklamanis, P. G., Mavrikakis, M., & Lekakis, J. P. (2006) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2006.04.001 · Cited by 15
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“This may be explained by the observation that the hemodynamic load on the heart is determined not only by high blood pressure, but also by arterial stiffness and blood viscosity ( 42 ,43, 44,45).”
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“As a consequence of arterial stiffness systolic blood pressure increases, generating an important rise in the left ventricle workload, which leads to oxygen consumption, ischemia, and left ventricle hypertrophy [21].”
Background
Predictive value of atrial high‐rate episodes for arterial stiffness and endothelial dysfunction in dual‐chamber pacemaker patients
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“Many different techniques have been used to study such parameters as regional flow and velocity, pulse wave propagation (11), and wave reflection (12,13), to name a few.”
Method
Treatment of isolated systolic hypertension
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“Both the rapidity of the return of the reflected wave, and its amplitude, have implications for left ventricular function [ 8 ].”
Background
Caffeine ingestion alters central hemodynamics following aerobic exercise in middle-aged men
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Primary and Secondary Hypertension
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“…by Papageorgiou and Jones (1987) that ‘true’ arterial taper (i.e. within-segment taper) is unlikely to be a typical (or at least haemodynamically significant) feature in healthy young adults, and that vascular beds are the main sites of wave reflection in the vasculature (O’Rourke & Kelly, 1993).”
Background
Interactions of ?-arginine, isosorbide mononitrate, and angiotensin II inhibitors on arterial pulse wave
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“The AIx is the one of the methods for arterial stiffness using arterial wave reflections and provides a measure of systemic arterial stiffness (25, 26).”
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Wave reflection in the arterial tree
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Background
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“This wave initially propagates from the heart to the periphery, but increases in complexity as it interacts on its way with the branching arterial tree and gets shaped because of wave reflection and transmission (O’Rourke and Kelly, 1993; Mitchell et al., 2004, 2011; Chirinos et al., 2019).”
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Chasing the reflected wave back into the heart: a new hypothesis while the jury is still out
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“Increased tone in the small vascular arteries increases central SBP and afterload of the left ventricle (16).”
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Authors: O??Rourke, M. F., & Kelly, R. P.
Affiliations: St Vincent's Hospital Sydney (AU)
ORCID: Kelly, Raymond P.
Venue: Journal of Hypertension
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1993-04
Volume: 11
Issue: 4
Pages: 327-337
ISSN: 0263-6352 (ISSN-L)
DOI: 10.1097/00004872-199304000-00001
OpenAlex: W2031720640
Cited by: 278
References: 0
Citations by year: 2026: 4 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 12 · 2013: 9 · 2012: 10
Type: journal article
Language: en
Open access: closed
Locations: Journal of Hypertension (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Keywords: wave reflection, systemic circulation, ventricular function, arterial stiffness, blood pressure, left ventricular function
MeSH terms: Adult, Aged, Aging, Animals, Biophysics, Blood Circulation, Female, Humans, Hypertension, Male, Middle Aged, Models, Cardiovascular, Ventricular Function, Biophysical Phenomena

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Wave reflection in the systemic circulation and its implications in ventricular function

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