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2014 ; 592
(17
): 3801-12
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Genesis of the characteristic pulmonary venous pressure waveform as described by
the reservoir-wave model
#MMPMID25015922
Bouwmeester JC
; Belenkie I
; Shrive NG
; Tyberg JV
J Physiol
2014[Sep]; 592
(17
): 3801-12
PMID25015922
show ga
Conventional haemodynamic analysis of pulmonary venous and left atrial (LA)
pressure waveforms yields substantial forward and backward waves throughout the
cardiac cycle; the reservoir wave model provides an alternative analysis with
minimal waves during diastole. Pressure and flow in a single pulmonary vein (PV)
and the main pulmonary artery (PA) were measured in anaesthetized dogs and the
effects of hypoxia and nitric oxide, volume loading, and positive-end expiratory
pressure (PEEP) were observed. The reservoir wave model was used to determine the
reservoir contribution to PV pressure and flow. Subtracting reservoir pressure
and flow resulted in 'excess' quantities which were treated as wave-related.Wave
intensity analysis of excess pressure and flow quantified the contributions of
waves originating upstream (from the PA) and downstream (from the LA and/or left
ventricle (LV)).Major features of the characteristic PV waveform are caused by
sequential LA and LV contraction and relaxation creating backward compression
(i.e.pressure-increasing) waves followed by decompression (i.e.
pressure-decreasing) waves. Mitral valve opening is linked to a backwards
decompression wave (i.e. diastolic suction). During late systole and early
diastole, forward waves originating in the PA are significant. These waves were
attenuated less with volume loading and delayed with PEEP. The reservoir wave
model shows that the forward and backward waves are negligible during LV
diastasis and that the changes in pressure and flow can be accounted for by the
discharge of upstream reservoirs. In sharp contrast, conventional analysis posits
forward and backward waves such that much of the energy of the forward wave is
opposed by the backward wave.