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Nat Rev Cardiol 2021 Feb 2. Epub 2021 Feb 2.

Institute for Pathophysiology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.

Unlike acute myocardial infarction with reperfusion, in which infarct size is the end point reflecting irreversible injury, myocardial stunning and hibernation result from reversible myocardial ischaemia-reperfusion injury, and contractile dysfunction is the obvious end point. Stunned myocardium is characterized by a disproportionately long-lasting, yet fully reversible, contractile dysfunction that follows brief bouts of myocardial ischaemia. Reperfusion precipitates a burst of reactive oxygen species formation and alterations in excitation-contraction coupling, which interact and cause the contractile dysfunction. Read More

Ter Arkh 2020 May 19;92(4):105-110. Epub 2020 May 19.

Penza State University.

An accurate quantitative assessment of myocardium necrosis area and the viable zone (stunned and hibernating) in patients with myocardial infarction is crucial for the preoperative patient selection and predicting the cardiac surgery effectiveness. Currently, researchers and clinicians are most interested in the problem of determining the viable myocardium zone. However, only the necrosis zone area directly correlates with the patients prognosis and determines the heart pathological remodeling processes. Read More

J Am Heart Assoc 2020 02 4;9(3):e015502. Epub 2020 Feb 4.

Huntington Medical Research Institutes Pasadena CA.

Curr Med Imaging Rev 2019;15(9):884-889

Department of Nuclear Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey.

Objective: This study evaluated how much of the myocardium was hibernating in patients with left ventricle dysfunction and/or comorbidities who planned to undergo either surgical or interventional revascularization. Furthermore, this study also identified which irrigation areas of the coronary arteries presented more scar and hibernating tissue.

Methods: At rest, Tc-99m MIBI SPECT and cardiac F-18 FDG PET/CT images collected between March 2009 and September 2016 from 65 patients (55 men, 10 women, mean age 64±12) were retrospectively analyzed in order to evaluate myocardial viability. Read More

Eur J Nucl Med Mol Imaging 2019 Oct 29;46(11):2322-2328. Epub 2019 Jul 29.

Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland.

Purpose: The human pathophysiology of stunned, hibernating and scarred myocardium in ischemic cardiomyopathy is a subject of controversy. While the "smart heart" theory postulates that reduced myocardial blood flow (MBF) at rest is responsible for myocytes switching to a state of hibernation, other theories suggest that a reduced myocardial flow reserve (MFR) may be the cause.

Methods: We included 110 patients with ischemic cardiomyopathy. Read More

J Nucl Cardiol 2019 04 26;26(2):374-386. Epub 2019 Feb 26.

INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA.

Background: Rb kinetics may distinguish scar from viable but dysfunctional (hibernating) myocardium. We sought to define the relationship between Rb kinetics and myocardial viability compared with conventional Rb and F-fluorodeoxyglucose (FDG) perfusion-metabolism PET imaging.

Methods: Consecutive patients (N = 120) referred for evaluation of myocardial viability prior to revascularization and normal volunteers (N = 37) were reviewed. Read More

Nucl Med Commun 2019 Apr;40(4):325-332

Nuclear Medicine.

Objectives: The association between the extent and degree of perfusion-metabolism mismatch and improvement in perfusion and left ventricular ejection fraction (LVEF) after revascularization was assessed. The secondary aim was to identify the best precoronary artery bypass graft surgery (pre-CABG) PET parameter, if any, to predict the improvement in the perfusion and LVEF after CABG.

Methods And Results: Overal, 31 patients (mean age: 58+8. Read More

Curr Heart Fail Rep 2018 08;15(4):214-223

The Rayne Institute, St Thomas' Hospital, 4th Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH, UK.

Purpose Of Review: Hibernation is an important and reversible cause of myocardial dysfunction in ischaemic heart failure.

Recent Findings: Hibernation is an adaptive process that promotes myocyte survival over maintaining contractile function. It is innate to mammalian physiology, sharing features with physiological hibernation in other species. Read More

Rev Assoc Med Bras (1992) 2017 Sep;63(9):793-800

Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. Read More

J Interv Card Electrophysiol 2017 Apr 25;48(3):247-254. Epub 2017 Jan 25.

Division of Cardiology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA.

Purpose: Hibernating myocardium (HM) is associated with sudden cardiac death (SCD). Little is known about the electrophysiological properties of HM and the basis of its association with SCD. We aimed to electrophysiologically characterize HM in patients with ventricular tachycardia (VT). Read More

J Am Coll Cardiol 2017 Jan;69(2):131-143

I. Medizinische Klinik und Poliklinik, University Clinic Rechts der Isar, Technical University of Munich, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; Walter-Brendel-Centre for Experimental Medicine, Ludwig Maximilian University of Munich, Munich, Germany. Electronic address:

Background: Diabetes mellitus causes microcirculatory rarefaction and may impair the responsiveness of ischemic myocardium to proangiogenic factors.

Objectives: This study sought to determine whether microvascular destabilization affects organ function and therapeutic neovascularization in diabetes mellitus.

Methods: The authors obtained myocardial samples from patients with end-stage heart failure at time of transplant, with or without diabetes mellitus. Read More

J Thorac Cardiovasc Surg 2017 03 16;153(3):582-590. Epub 2016 Nov 16.

Department of Surgery, University of Minnesota, Minneapolis, Minn.

Objective: Clinical studies demonstrate delayed recovery of hibernating myocardium (HM) following coronary artery bypass graft (CABG) surgery. Cardiac magnetic resonance (CMR) imaging is effective in identifying HM in clinical settings. Our animal model of HM shows partial but incomplete functional recovery 1 month following CABG using echocardiography. Read More

J Cardiovasc Transl Res 2016 08 16;9(4):368-73. Epub 2016 May 16.

Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

There is conflicting clinical evidence whether administration of coenzyme Q10 (CoQ10) improves function following coronary artery bypass graft surgery (CABG). Using a swine model of hibernating myocardium, we tested whether daily CoQ10 would improve contractile function by MRI at 4-week post-CABG. Twelve pigs underwent a thoracotomy and had a constrictor placed on the left anterior descending (LAD). Read More

Eur Heart J 2017 04;38(13):942-954

Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK.

The terms used to describe different states of myocardial health and disease are poorly defined. Imprecision and inconsistency in nomenclature can lead to difficulty in interpreting and applying trial outcomes to clinical practice. In particular, the terms 'viable' and 'hibernating' are commonly applied interchangeably and incorrectly to myocardium that exhibits chronic contractile dysfunction in patients with ischaemic heart disease. Read More

Basic Res Cardiol 2015 Nov 29;110(6):55. Epub 2015 Sep 29.

Università Vita Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy.

Ivabradine is an effective treatment for angina in patients with stable coronary artery disease (CAD) and for heart failure. Experiments in a canine model have shown that ivabradine reduces both acute left ventricular (LV) dysfunction and post-ischaemic stunning. Aim of this study was to investigate the effect of ivabradine on LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. Read More

Circ Res 2015 Sep 13;117(7):634-44. Epub 2015 Aug 13.

From the Departments of Medicine, Physiology and Biophysics and Biomedical Engineering, and the Clinical and Translational Research Center, University at Buffalo and the VA WNY Health Care System, NY.

Rationale: Allogeneic bone marrow-derived mesenchymal stem cells (MSCs) and cardiosphere-derived cells (CDCs) have each entered clinical trials, but a direct comparison of these cell types has not been performed in a large animal model of hibernating myocardium.

Objective: Using completely blinded methodology, we compared the efficacy of global intracoronary allogeneic MSCs (icMSCs, ≈35×10(6)) and CDCs (icCDCs, ≈35×10(6)) versus vehicle in cyclosporine-immunosuppressed swine with a chronic left anterior descending coronary artery stenosis (n=26).

Methods And Results: Studies began 3 months after instrumentation when wall thickening was reduced (left anterior descending coronary artery % wall thickening [mean±SD], 38±11% versus 83±26% in remote; P<0. Read More

Biomed Res Int 2015 29;2015:587361. Epub 2015 Jun 29.

Division of Cardiovascular Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA ; Section of Cardiology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC6080, Chicago, IL 60637, USA.

Atrial fibrillation (AF) is the most common arrhythmia and is associated with a high risk of morbidity and mortality. However, there are limited treatment strategies for prevention of disease onset and progression. Development of novel therapies for primary and secondary prevention of AF is critical and requires improved understanding of the cellular and molecular mechanisms underlying the AF disease process. Read More

Klin Med (Mosk) 2015 ;93(4):25-30

The paper reports results of endovascular treatment of 66 patients with post-infarction cardiosclerosis. It was shown that normalization of coronary circulation in patients with viable hibernating myocardium in the zone of the affected artery not only eliminates the signs of chronic ischemia and slows down post-infarction heart remodeling but also restores the lost functions of hibernating myocardium which has beneficial influence on prognosis of the disease. Functioning of hibernating myocardium depends on the timely restoration of coronary circulation. Read More

J Cardiovasc Transl Res 2015 Jun 7;8(4):244-52. Epub 2015 May 7.

Cardiology Division, VA Medical Center, University of Minnesota, Minneapolis, MN, USA.

Clinicians often use the term "hibernating myocardium" in reference to patients with ischemic heart disease and decreased function within viable myocardial regions. Because the term is a descriptor of nature's process of torpor, we provide a comparison of the adaptations observed in both conditions. In nature, hearts from hibernating animals undergo a shift in substrate preference in favor of fatty acids, while preserving glucose uptake and glycogen. Read More

Prog Cardiovasc Dis 2015 May-Jun;57(6):537-54. Epub 2015 Feb 27.

John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine.

How do we define myocardial ischemia? This is an important question for clinicians and one that, while conceptually straight forward, can be practically difficult to assess. In this article we describe the various imaging methods available in cardiology to quantify myocardial ischemia. Anatomic assessments of ischemia such as angiography, while the "gold standard", have limitations. Read More

J Am Coll Cardiol 2015 Feb;65(7):698-700

Cardiovascular Research Center, Temple University School of Medicine, Philadelphia, Pennsylvania; and the Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy. Electronic address:

J Am Coll Cardiol 2015 Feb;65(7):684-97

UB Clinical and Translational Research Center and Department of Medicine, University at Buffalo, Buffalo, New York; VA Western New York Health Care System, Buffalo, New York; Department of Physiology and Biophysics and Department of Biomedical Engineering, University at Buffalo, Buffalo, New York. Electronic address:

Background: The time course and extent of recovery after revascularization of viable dysfunctional myocardium are variable. Although fibrosis is a major determinant, myocyte structural and molecular remodeling may also play important roles.

Objectives: This study sought to determine whether persistent myocyte loss and/or irreversibility of protein changes that develop in hibernating myocardium have an impact on functional recovery in the absence of infarction. Read More

J Surg Res 2015 May 7;195(1):29-36. Epub 2015 Jan 7.

Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Department of Cardiothoracic Surgery, Minneapolis VAHCS, Minneapolis, Minnesota. Electronic address:

Background: Hibernating myocardium is characterized by viable yet dysfunctional myocardium secondary to chronic ischemia, with studies demonstrating incomplete early recovery after coronary artery bypass graft (CABG). We tested whether mitochondrial fusion proteins, an indicator of mitochondrial biogenesis, are increased in hibernating myocardium post-CABG.

Methods: A constrictor was placed on the left anterior descending (LAD) artery of nine pigs. Read More

J Card Surg 2015 Feb 3;30(2):224-31. Epub 2014 Dec 3.

Department of Surgery, University of Minnesota, Minneapolis, Minnesota.

Myocardial responses to chronic ischemia represent a continuum of adaptations resulting, over time, in a stress-resistant phenotype. One such adaptation, hibernating myocardium (HM), has increased antioxidant capacity that protects against ischemia-induced oxidative stress. Studies have suggested that revascularization alone may not fully restore cardiac function, highlighting the need for targeted therapies to serve as adjuncts to the innate healing process following revascularization. Read More

Nucl Med Commun 2015 Feb;36(2):148-55

aDepartment of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, Maebashi bDepartment of Cardiovascular Surgery, Tsukazaki Hospital, Hyogo cDepartment of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan.

Background: A mismatch between thallium-201 ((201)Tl) and iodine-123 ((123)I)-beta-methyl iodophenyl pentadecanoic acid (BMIPP) dual single-photon emission computed tomography (SPECT) reflects a dysfunctional but viable myocardium, such as stunned or hibernating myocardium, in patients with coronary artery disease (CAD). However, the cardiac function does not always improve after revascularization. The present study aimed to determine whether serial (201)Tl and (123)I-BMIPP dual SPECT can predict improvements in cardiac function after coronary artery bypass graft surgery (CABG) in patients with CAD. Read More

J Cardiovasc Magn Reson 2014 Oct 3;16:83. Epub 2014 Oct 3.

Department of Cardiovascular Medicine, Vilnius University; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania.

Background: This study sought to evaluate the relation between long-term segmental and global functional outcome after revascularisation in patients with chronic ischaemic left ventricular dysfunction (LVD) and baseline markers of viability: late gadolinium enhancement (LGE) transmurality and contractile reserve (CR).

Methods: Forty-two patients with chronic ischaemic LVD underwent low-dose dobutamine- (LDD) and late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) before surgical or percutaneous revascularisation. Regional and global left ventricular (LV) functions and LGE were repeatedly assessed 6 ± 1 and 35 ± 6 months after revascularisation. Read More

J Surg Res 2015 Jan 8;193(1):15-21. Epub 2014 Aug 8.

Department of Surgery, University of Minnesota, Minneapolis, MN; Department of Surgery, University of Minnesota, Minneapolis, MN. Electronic address:

Background: We have previously shown that mitochondrial uncoupling protein-2 (UCP-2) is increased in a swine model of hibernating myocardium (HM). Although UCP-2 reduces oxidant stress, it can promote inefficiency of the electron transport chain. In this study, we tested whether UCP-2 remains increased in revascularized HM (RHM) after coronary artery bypass grafting (CABG). Read More

Trans Am Clin Climatol Assoc 2014 ;125:141-53; discussion 153

Buffalo, New York.

Between 184,000 and 462,000 Americans die suddenly each year. Fifty percent to 70% of these deaths are due to ventricular tachycardia/fibrillation (VT/VF). We tested whether hibernating myocardium or myocardial sympathetic denervation identifies patients at high-risk for developing VT/VF independently of ejection fraction (EF). Read More

Zhongguo Zhong Yao Za Zhi 2014 Apr;39(7):1311-4

Coronary artery disease (CAD) is one of the leading causes of death. Safflower attracts great attention owing to its anti-ischemia/reperfusion injury effect. Ninety-three patients with CAD were included and randomized into safflower treatment group, PCI group and control group. Read More