Patients with refractory angina have increased aortic wave reflection and wasted left ventricular pressure energy

RA patients have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand and wasted LV energy and reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand ratio that favors ischemia and angina pectoris and may precipitate future adverse cardiovascular events.