Wave intensity amplification and attenuation in non-linear flow: implications for the calculation of local reflection coefficients.

Local reflection coefficients (R) provide important insights into the influence of wave reflection on vascular haemodynamics. Using the relatively new time-domain method of wave intensity analysis, R has been calculated as the ratio of the peak intensities (R(PI)) or areas (R(CI)) of incident and reflected waves, or as the ratio of the changes in pressure caused by these waves (R(DeltaP)). While these methods have not yet been compared, it is likely that elastic non-linearities present in large arteries will lead to changes in the size of waves as they propagate and thus errors in the calculation of R(PI) and R(CI). To test this proposition, R(PI), R(CI) and R(DeltaP) were calculated in a non-linear computer model of a single vessel with various degrees of elastic non-linearity, determined by wave speed and pulse amplitude (DeltaP(+)), and a terminal admittance to produce reflections. Results obtained from this model demonstrated that under linear flow conditions (i.e. as DeltaP(+)-->0), R(DeltaP) is equivalent to the square-root of R(PI) and R(CI) (denoted by R(PI)(p) and R(CI)(p)). However for non-linear flow, pressure-increasing (compression) waves undergo amplification while pressure-reducing (expansion) waves undergo attenuation as they propagate. Consequently, significant errors related to the degree of elastic non-linearity arise in R(PI) and R(CI), and also R(PI)(p) and R(CI)(p), with greater errors associated with larger reflections. Conversely, R(Delta)(P) is unaffected by the degree of non-linearity and is thus more accurate than R(PI) and R(CI).