The hibernating myocardium in ischaemia and congestive heart failure

ure, left ventricular dysfunction, cardiac transplantation, coronary bypass surgery, percutaneous transluminal coronary angioplasty. Hibernating myocardium refers to the presence of persistent myocardial and left ventricular dysfunction at rest due to reduced coronary blood flow that can be partially or completely restored to normal by myocardial revascularization. An increasing amount of data show it is most likely a downgrading of cardiac function so that blood flow and myocardial func-tion are once again in a state of equilibrium. It has been demonstrated to occur in patients with unstable angina, chronic stable angina, acute myocardial infarction and in left ventricular dysfunction and/or congestive heart failure. Salvage of this viable myocardium by successful revascular-ization improves left ventricular dysfunction and probably also patient survival. Therefore, diagnosis of hibernating myocardium is important because it does not render left ventricular dysfunction a necessary contraindication to revascularization, nor does it leave the patient with chronic heart failure a candidate only for cardiac transplantation. Instead, these patients should have complete revascularization by coronary bypass surgery/ percutaneous transluminal coronary angioplasty as soon as possible. Hibernating myocardium is a state of persistently impaired myocardial and left ventricular (LV) function at rest due to reduced coronary blood flow that can be partially or com-pletely restored to normal if the myocardial oxygen sup-ply/demand relationship is favourably altered, either by improving blood flow and/or by reducing demand (Fig. I)"'2'. Left ventricular dysfunction at rest can be the result o