Hibernating Myocardium

  • Roberto Ferrari
Part of the Progress in Experimental Cardiology book series (PREC, volume 1)


Left ventricular dysfunction is in most cases the consequence of myocardial ischemia. It may occur transiently during an attack of angina, and it is usually reversible. It may persist over hours or even days in patients after an episode of ischemia followed by reperfusion, leading to the condition known as stunning.

In patients with persistent limitation of coronary flow, left ventricular dysfunction may be present over months and years or indefinitely in subjects with fibrosis, scar formation, and remodeling after myocardial infarction. Chronic left ventricular dysfunction, however, does not mean permanent or irreversible cell damage. Hypoperfused myocytes can remain viable but akinetic. This type of dysfunction has been called hibernating myocardium.

Unfortunately, left ventricular dysfunction might also result from irreversible damage, leading to remodeling and heart failure.

The dysfunction due to hibernation can be partially or completely restored to normal by reperfusion. Thus, it is important to clinically recognize the hibernating myocardium.

In this chapter, we evaluate stunning, hibernation, and remodeling with respect to clinical decision making and, where possible, we refer to our own ongoing clinical experience.


Ventricular Dysfunction Coronary Flow Coronary Flow Reserve Stun Myocardium Contractile Reserve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rahimtoola S. 1989. The hibernating myocardium. Am Heart J 117:211–221.PubMedCrossRefGoogle Scholar
  2. 2.
    Bolli R. 1993. Myocardial stunning in man. Circulation 86:1671–1691.Google Scholar
  3. 3.
    Takahashi A, Ono Y, Shishido F, Uemura K, Kadowaki K, Kumagai T. 1990. PET evaluations oi ischemic heart disease showing transient ST-T elevation: report of two cases. J Cardiol 20:241–248.PubMedGoogle Scholar
  4. 4.
    Kobayashi T, Imagawa H, Satoh H, Yoshino T, Fudemoto Y, Matsuwaka R. 1991. Biventricular assist support using centrifugal pump in cardiogenic shock following coronary bypass grafting: a case report of long survival. J Jpn Assoc Thorac Surg 39:924–929.Google Scholar
  5. 5.
    Shahian DM, St Ledger S, Kimell W, Bogosian M, Abraham W, Johnson ME. 1990. Successful recovery of postischemic stunned myocardium using centrifugal left ventricular assist. J Cardiothorac Anesth 4:84–88.PubMedCrossRefGoogle Scholar
  6. 6.
    Bolli R. 1990. Mechanism of myocardial “stunning.” Circulation 82:723–738.PubMedGoogle Scholar
  7. 7.
    Eitzman D, Al-Aouar Z, Kanter HL, vom Dahl J, Kirsh M, Deeb GM, Schwaiger M. 1992. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography. J Am Coil Cardiol 20:559–565.CrossRefGoogle Scholar
  8. 8.
    Ross J Jr. 1991. Myocardial perfusion—contraction matching: implications for coronary heart disease and hibernation. Circulation 83:1076–1082.PubMedGoogle Scholar
  9. 9.
    Schultz R, Guth BD, Pieper K, Martin C, Heusch G. 1992. Recruitment of an inotropic reserve in moderately ischemic myocardium at the expense of metabolic recovery: a model of short-term hibernation. Circ Res 70:1282–1295.Google Scholar
  10. 10.
    Ferrari R, Visioli O. 1991. Stunning: damaging or protective to the myocardium? Cardiovasc Drugs Ther 5:939–946.PubMedCrossRefGoogle Scholar
  11. 11.
    Ferrari R, Cargnoni A, Curello S, Ceconi C, Volpini M, Visioli O. 1993. Metabolic adaptation of underperfused isolated rabbit heart: an insight into molecular mechanisms underlying hibernation. Circulation 88(4):1004.Google Scholar
  12. 12.
    Dilsizian V, Bonow R. 1993. Current diagnostic techniques of assessing myocardial viability in patients with hibernating and stunned myocardium. Circulation 87:1–20.PubMedGoogle Scholar
  13. 13.
    Giubbini R, Alfieri O, Ferrari R, Milan E, Rossini P, Lorusso R, Berra P, La Canna G. 1993. Thallium rest-redistribution and echo-dobutamine tests to predict functional improvement after bypass surgery in patients with left ventricular dysfunction. Circulation 88(4):2883.Google Scholar
  14. 14.
    Cigarroa CG, De Filippi CR, Brickner ME, Alvarez LG, Wait MA, Grayburn PA. 1993. Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization. Circulation 88:430–436.PubMedGoogle Scholar
  15. 15.
    La Canna G, Alfieri O, Giubbini R, Gargano M, Ferrari R, Visioli O. 1994. Echocardiography during infusion of dobutamine for identification of reversible dysfunction in patients with chronic coronary artery disease. J Am Coll Cardiol 23:617–626.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Roberto Ferrari
    • 1
  1. 1.Universita’ degli Studi di BresciaItaly

Personalised recommendations