Waves and Windkessels reviewed

Abstract

Pressure and flow are travelling waves and are reflected at many locations. The forward and reflected waves, obtained by wave separation, are compound waves. This compounded character of the reflected wave explains why its magnitude decreases with increased peripheral resistance, why it appears to run forward rather than backward, and why its return time relates poorly with aortic wave speed. A single tube (aorta) with distal reflection is therefore an incorrect arterial model. Wave Intensity Analysis (WIA) uses time derivatives of pressure and flow, augmenting rapid changes and incorrectly suggesting a ‘wave free period’ in diastole. Assuming a ‘wave free period’, the Reservoir-Wave Approach (RWA) separates pressure into a ‘waveless’ reservoir pressure, predicted by Frank's Windkessel, and excess pressure, accounting for wave phenomena. However, the reservoir pressure, being twice the backward pressure, and location dependent, is a wave. The Instantaneous wave Free pressure Ratio distal and proximal of a stenosis, iFR, also assumes a ‘wave free period’, and is based on an instantaneous pressure-flow ratio, an incorrect resistance measure since Ohm's law pertains to averaged pressure and flow only. Moreover, this ratio, while assumed minimal, was shown to decrease with vasodilation.Windkessel models are descriptions of an arterial system at a single location using a limited number of parameters. Windkessels can be used as model but the actual arterial system is not a Windkessel. Total Peripheral Resistance and Total Arterial Compliance, (the 2-element, Frank Windkessel), supplemented with aortic characteristic impedance (3-element Windkessel) mimics the arterial system well.