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Aortic stiffness and myocardial ischemia.

All too often, myocardial ischemia is considered synonymous with coronary artery disease, as if coronary atherosclerotic phenomena were the only responsible mechanism for myocardial ischemia. On the contrary, a more correct approach to ischemic heart disease would need to consider all the factors potentially responsible for an ischemic myocardial injury, besides atherosclerotic coronary stenosis. Among them, we should consider myocardial oxygen needs, myocardial (subendocardial) flow supply, and the arterial oxygen content. In order to better understand the link between arterial stiffness and myocardial ischemia, it is, thus, necessary to consider ischemic heart disease through a very broad perspective, namely, as the complex balance between subendocardial oxygen supply and demand.