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(Circulation. 2008;117:103-114.)
© 2008 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Stunning, Hibernation, and Assessment of Myocardial Viability

Paolo G. Camici, MD, FESC, FRCP; Sanjay Kumak Prasad, MD, MRCP; Ornella E. Rimoldi, MD

From the Medical Research Council Clinical Sciences Centre and National Heart and Lung Institute, Imperial College School of Medicine, London, UK (P.G.C., S.K.P., O.E.R.), and Cardiovascular Research Institute, Department of Medicine, New York Medical College, Valhalla (O.E.R.).

Correspondence to Professor Paolo G. Camici, MRC Clinical Sciences Centre, Hammersmith Hospital, Du Cane Rd, London W12 0NN, UK. E-mail paolo.camici@csc.mrc.ac.uk

Key Words: heart failure • hibernation • stunning, myocardial

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The last 3 decades have witnessed an unprecedented improvement in the outcome of patients with acute coronary syndromes. The widespread use of thrombolytic therapy and percutaneous coronary interventions, in association with increasingly potent antithrombotic agents, has contributed to significant reductions in mortality and morbidity in these patients. Although overall survival has improved, a downside of this success has been the greater number of patients with residual left ventricular (LV) dysfunction undergoing progressive LV remodeling and congestive heart failure. This problem is compounded by the rising age of our population and the higher prevalence of comorbidities such as diabetes mellitus that confer an increased risk of coronary artery disease (CAD) and congestive heart failure. Patients with CAD represent by far the most numerous cohort among those with congestive heart failure, and their treatment remains a partial success.¹ Typically, these patients have multivessel disease, increased LV volumes, and variable degrees of regional and/or global systolic dysfunction, although more cases of isolated diastolic dysfunction have been reported recently.^2–4 In these patients, coronary revascularization may lead to symptomatic and prognostic improvement, and these clinical benefits are accompanied by evidence of reverse LV remodeling. In this context, the concept of myocardial viability was developed and a number of different techniques have been used to demonstrate the presence of viable tissue before coronary revascularization.

The aim of this review article is to summarize our current understanding of the concept of myocardial viability and its clinical implications in patients with CAD and chronic LV dysfunction. Throughout this . . . [Full Text of this Article]

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