Hibernating Myocardium

Abstract

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.