2 ARTERIAL EFFECTIVE REFLECTING SITES MAY APPEAR AS ONE TO THE HEART

The relation between reflected waves and features of ascending aortic pressure waveforms and impedance patterns was investigated with a modified T-tube model of the systemic arterial circulation. Ascending aortic pressure and flow and descending aortic flow were measured in 10 dogs under basal conditions and under the effect of an agent (methoxamine) that caused vasoconstriction and an increase of mean aortic pressure. A broad range of aortic pressure amplitudes and features was obtained. These waveshapes were classified into four groups. Under basal conditions, cases for which a prominent diastolic fluctuation was present (n = 8) were grouped in A. Cases for which this fluctuation was absent (n = 2) were grouped in B. Groups C (n = 4) and D (n = 3) included cases that, under vasoconstricted conditions, did or did not display, respectively, a diastolic fluctuation in pressure. Arterial T-tube model parameters were estimated by simultaneously fitting the model to both ascending and descending aortic flows with aortic pressure as input. A good fit was obtained in any case considered. After parameter estimation, forward and reflected waves and impedance patterns at the entrance of head circulation (head and upper limbs) and body circulation (trunk and lower limbs) as well as their merger in the ascending aorta were determined. T-tube input impedance compared well with impedance data points obtained from the ratio of corresponding harmonics of ascending aortic pressure and flow. In some cases (group A), modulus and phase spectra displayed two distinct minima, in the range from 0 to 10 Hz. In some other circumstances, these minima were less distinct (groups B and C) and could even appear as one (group D). Whether one or two minima appeared in the ascending aortic impedance spectra at low frequency and whether a prominent diastolic fluctuation did or did not appear in aortic pressure, pressure and flow waveshapes proximal to the heart were explained by the presence of two effective reflecting sites in the systemic circulation. In group B, a diastolic fluctuation in pressure was absent despite the fact that head-end and body end reflected waves were distinct. This happened because body-end reflected waves peaked corresponding to a minimum of the head-end reflected wave. In group D, a diastolic fluctuation in aortic pressure was absent because the body-end reflected wave moved into systole and superimposed on the head-end reflected wave. This superimposition was due to increased pulse wave velocity in the body transmission path as a result of decreased arterial distensibility. After comparing our T-tube model with a single-tube model representation of systemic circulation, we concluded that, in cases like those grouped in D, two effective reflecting sites appear as one to the heart.