Figure 5: The Impact of Wave Reflections on Late Systolic Load.

Wave reflections increase late systolic left ventricular load, which favours left ventricle remodelling and myocardial dysfunction. However, the effect of wave reflection on myocardial load is modulated by contraction pattern and the time course of myocardial wall stress. Left ventricles in which mid-systolic shift in the pressure–stress relation is impaired (due to a reduced ejection fraction, concentric geometric remodelling, and/or reduced early systolic ejection) fail to protect cardiomyocytes against the load induced by wave reflections in late systole, a period of vulnerability to load. This may represent a vicious cycle that favours the development and furthers progression of heart failure. LVH = left ventricular hypertrophy.