Hibernating and stunned myocardium: Pathophysiological considerations

Part of the Developments in Cardiovascular Medicine book series (DICM, volume 226)


The mortality from ischemic heart disease has decreased in recent years. The better understanding of risk factors associated with development of coronary artery disease (CAD) has significantly contributed to this decline. Preventive measures such as aggressive therapy of arterial hypertension, diabetes mellitus, lipid disorders and by campaigning against smoking are important components of this medical success. Furthermore, improvements in medical and interventional therapy have reduced the complications associated with acute myocardial infarction as well as revascularization. Patients with advanced CAD appear to benefit most from interventional therapy. Several studies indicate that patients with poor left ventricular function and multivessel disease show improved clinical outcome after surgical revascularization [1–5]. The reversibility of myocardial dysfunction is an important factor contributing to the beneficial effect of revascularization. On the other hand, the risks associated with revascularization are highest in patients with poor left ventricular function [5]. Therefore, noninvasive techniques have been developed to select these patients based on evidence of tissue viability in dysfunctioning myocardium. During the last 30 years, there has been increasing clinical awareness that myocardial dysfunction in patients with CAD does not necessarily reflect scarred tissue [6,7]. In the 1970s, contractile reserve demonstrated in the catheterization laboratory by infusion of catecholamines or postextrasystolic potentiation were parameters, which identified reversibility of left ventricular dysfunction [8,9]. After the introduction of imaging modalities, the noninvasive characterization of regional function, perfusion and metabolism allowed for more sophisticated tissue characterization to identify reversible dysfunction with high diagnostic and prognostic accuracy [10]. At the same time, experimental investigations were initiated to reproduce the clinical observations in the animal laboratory [11]. Although there is no established animal model for chronic CAD associated with left ventricular dysfunction, acute and chronic animal models do successfully reproduce reversible left ventricular dysfunction [12].


Myocardial Perfusion Myocardial Blood Flow Left Ventricular Dysfunction Wall Motion Abnormality Myocardial Dysfunction 
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