If blood flow's reduced or the myocardium is thicker, blood has a harder time reaching this deeper layer just under the endocardium, called the subendocardium.
Yet another is endocardial fibroelastosis, where fibrosis develops in the endocardium, the inner lining of the heart, as well as the subendocardium right under, again making the tissue less compliant.
Finally, there's the innermost layer of the heart called the endocardium, which is made of a relatively thin layer of endothelium which is the same layer of cells that line the blood vessels.
Whatever the case, the heart needs blood, and if we look at the heart wall, there's three layers—the outermost layer, the epicardium, then the myocardium in the middle, and the endocardium inside the heart.