Search Our Scientific Publications & Authors

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 Feb 4;9(3):e015502. Epub 2020 Feb 4.

Huntington Medical Research Institutes Pasadena CA.

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

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

J Nucl Cardiol 2014 Jun 15;21(3):578-87. Epub 2014 Mar 15.

Department of Nuclear Medicine, University of Munich, Munich, Germany.

Background: To evaluate the influence of SPECT attenuation correction on the quantification of hibernating myocardium derived from perfusion SPECT and (18)F-FDG PET.

Methods And Results: 20 patients underwent rest (99m)Tc-tetrofosmin perfusion SPECT/CT and (18)F-FDG PET/CT. Perfusion images were reconstructed without attenuation correction (NC), with attenuation correction based on the CT from the SPECT/CT (AC_SPECT), and with attenuation correction based on the CT from the PET/CT (AC_PET). Read More

Cardiol Rev 2014 Sep-Oct;22(5):246-52

From the *Departments of Internal Medicine; †Division of Cardiology; and ‡Department of Radiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Established coronary artery disease has a prevalence of 7% in adult Americans, accounting for 16 million people. As morbidity and mortality rates have risen, research efforts to identify the pathophysiologic mechanisms of systolic dysfunction have risen in parallel. The current goal is to develop new therapeutic strategies with the potential to reverse systolic dysfunction in patients with established coronary artery disease. Read More

Hell J Nucl Med 2014 Jan-Apr;17(1):10-1. Epub 2014 Feb 25.

Department of Nuclear Medicine, Faculty of Medicine, Bozok University, Yozgat, Turkey.

Assessment of left ventricular (LV) function in patients with myocardial infarction (MI) provide useful diagnostic and prognostic information. Up to date, single photon emission tomography (SPET), positron emission tomography (PET), multidetector computed tomographic angiography, echocardiography (EC) and magnetic resonance imaging (MRI), have been used to examine LV parameters. However, due to limitations of some imaging methods, new studies are directed to improve myocardium function evaluation. Read More

Cardiovasc Pathol 2014 May-Jun;23(3):160-8. Epub 2014 Jan 10.

Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium.

Introduction: Our goal was to show that blunting of myocardial flow reserve is mainly involved in adaptive chronic myocardial hibernation without apparent cardiomyocyte degeneration.

Methods And Results: Sheep chronically instrumented with critical multivessel stenosis and/or percutaneous transluminal coronary angioplasty (PTCA)-induced revascularization were allowed to run and feed in the open for 2 and 5 months, respectively. Regional myocardial blood flow (MBF) with colored microspheres, regional and global left ventricular function and dimensions (2D echocardiography), and myocardial structure were studied. Read More

J Thorac Imaging 2014 May;29(3):134-46

Departments of *Radiology †Nuclear Medicine ‡Cardiovascular Diseases, UZ Leuven, Leuven, Belgium.

Ischemic heart failure is probably the most challenging issue in cardiology today, posing an enormous medical and financial burden on our society. Conceptually, it represents a maladaptive cardiac remodeling due to acute and/or chronic coronary artery disease with varying degrees of left ventricular dilatation and dysfunction. Although therapeutic options have improved overall survival over the years, mortality rates remain high, and in daily practice cardiologists not infrequently face the therapeutic dilemma whether a revascularization procedure will lead to symptomatic and prognostic benefit for the patient. Read More

J Cell Mol Med 2014 Mar 20;18(3):396-414. Epub 2014 Jan 20.

Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione CNR-Regione Toscana "G. Monasterio", Pisa, Italy.

Myocardial hibernation (MH) is a well-known feature of human ischaemic cardiomyopathy (ICM), whereas its presence in human idiopathic dilated cardiomyopathy (DCM) is still controversial. We investigated the histological and molecular features of MH in left ventricle (LV) regions of failing DCM or ICM hearts. We examined failing hearts from DCM (n = 11; 41. Read More

Rev Port Cardiol 2013 Oct;32(10):845-6

Int J Cardiovasc Imaging 2014 Feb 20;30(2):415-23. Epub 2013 Nov 20.

Nuclear Medicine Department, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, CEP: 05403-000, Brazil.

Positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) is considered the gold standard for myocardial viability. A pilot study was undertaken to compare FDG-PET using euglycemic hyperinsulinemic clamp before (18)F-fluorodeoxyglucose ((18)F-FDG) administration (PET-CLAMP) with a new proposed technique consisting of a 24-h low-carbohydrate diet before (18)F-FDG injection (PET-DIET), for the assessment of hypoperfused but viable myocardium (hibernating myocardium). Thirty patients with previous myocardial infarction were subjected to rest (99m)Tc-sestamibi-SPECT and two (18)F-FDG studies (PET-CLAMP and PET-DIET). Read More

Circ Cardiovasc Imaging 2013 Nov 2;6(6):982-91. Epub 2013 Oct 2.

Division of Cardiac Surgery, Molecular Function and Imaging Program at the Cardiac PET Centre, Division of Cardiology, and Department of Cellular and Molecular Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Background: Vasculogenic cell-based therapy combined with tissue engineering is a promising revascularization approach targeted at patients with advanced coronary artery disease, many of whom exhibit myocardial hibernation. However, to date, no experimental data have been available in this context; we therefore examined the biopolymer-supported delivery of circulating angiogenic cells using a clinically relevant swine model of hibernating myocardium.

Methods And Results: Twenty-five swine underwent placement of an ameroid constrictor on the left circumflex artery. Read More

Coron Artery Dis 2013 Sep;24(6):493-500

Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China.

Objective: The present study was designed to investigate whether microvascular remodeling could occur in hibernating myocardium and infarction regions distal to a total occluded coronary artery after acute myocardial infarction.

Materials And Methods: Copper stents were implanted in the left descending coronary arteries of 64 pigs to induce anterior wall myocardial infarction. The pigs were assigned randomly to group A (n=8; killed at 1 week), group B (n=8; killed at 2 weeks), group C (n=16; killed at 4 weeks), group D (n=16; killed at 3 months), and group E (n=16; killed at 6 months). Read More

J Nucl Cardiol 2013 Oct;20(5):908-12

Cardiovascular Division, Department of Internal Medicine, School of Medicine, Washington University in Saint Louis, Campus Box 8086, 660 S. Euclid Avenue, Saint Louis, MO, 63110, USA,

Circ Cardiovasc Imaging 2013 May;6(3):355-7

Circ Cardiovasc Imaging 2013 May 17;6(3):363-72. Epub 2013 Apr 17.

Heart and Vascular Institute and Imaging Institute, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.

Background: Although the recent surgical treatment of ischemic heart failure substudy reported that revascularization of viable myocardium did not improve survival, these results were limited by the viability imaging technique used and the lack of inducible ischemia information. We examined the relative impact of stress-rest rubidium-82/F-18 fluorodeoxyglucose positron emission tomography identified ischemia, scar, and hibernating myocardium on the survival benefit associated with revascularization in patients with systolic dysfunction.

Methods And Results: The extent of perfusion defects and metabolism-perfusion mismatch was measured with an automated quantitative method in 648 consecutive patients (age, 65±12 years; 23% women; mean left ventricular ejection fraction, 31±12%) undergoing positron emission tomography. Read More

Am J Physiol Heart Circ Physiol 2013 Jun 12;304(12):H1697-707. Epub 2013 Apr 12.

Veterans Affairs Western New York Health Care System, Buffalo, NY, USA.

Many survivors of sudden cardiac death (SCD) have normal global ventricular function and severe coronary artery disease but no evidence of symptomatic ischemia or infarction before the development of lethal ventricular arrhythmias, and the trigger for ventricular tachycardia (VT)/ventricular fibrillation (VF) remains unclear. We sought to identify the role of spontaneous ischemia and temporal hemodynamic factors preceding SCD using continuous telemetry of left ventricular (LV) pressure and the ECG for periods up to 5 mo in swine (n = 37) with hibernating myocardium who experience spontaneous VT/VF in the absence of heart failure or infarction. Hemodynamics and ST deviation at the time of VT/VF were compared with survivors with hibernating myocardium as well as sham controls. Read More

Eur Heart J 2013 May 17;34(18):1323-36. Epub 2013 Feb 17.

Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.

A very large body of evidence--predominantly retrospective--suggests that revascularization is superior to optimal medical therapy in patients with a significant amount of 'hibernating' myocardium. Contemporary cardiological practice has embraced this standard of practice, as many centres worldwide place great emphasis upon the results of viability testing by non-invasive imaging techniques in determining the need for coronary revascularization. This practice has been challenged by the recent results of the Surgical Treatment for Ischaemic Heart Failure (STICH) trial, which suggested both lack of mortality benefit from revascularization and also from viability testing. Read More

Curr Pharm Des 2013 ;19(22):3996-4002

Hospital Virgen de la Victoria, Campus Universitario Teatinos, C.P. 29010, Malaga, Spain.

Recently, many studies have shown a decrease in myocardial damage in patients undergoing coronary artery bypass surgery where the anesthetic agent used was sevoflurane compared with propofol. The basis for this protective effect of the myocardium occurs through the mechanisms of preconditioning and postconditioning of halogenated agents. Both relate to the benefit of prior or subsequent administration of the drug (halogenated anesthetic agent) to the harmful stimulus for myocardial cells. Read More

Am J Physiol Heart Circ Physiol 2013 Jan 2;304(2):H318-27. Epub 2012 Nov 2.

Center for Research in Cardiovascular Medicine, University at Buffalo, Buffalo, NY 14203, USA.

Hibernating myocardium due to chronic repetitive ischemia is associated with regional sympathetic nerve dysfunction and spontaneous arrhythmic death in the absence of infarction. Although inhomogeneity in regional sympathetic innervation is an acknowledged substrate for sudden death, the mechanism(s) responsible for these abnormalities in viable, dysfunctional myocardium (i.e. Read More

Heart Lung Circ 2012 Aug 20;21(8):468-79. Epub 2012 Apr 20.

Department of Cardiovascular Medicine, Discipline of Medicine, Flinders University of South Australia, Flinders Medical Centre, Australia.

Patients with severe left ventricular (LV) dysfunction and multi-vessel coronary artery disease (CAD) are at high risk during revascularisation, however they are also likely to derive the most benefit. Historically, the detection of dysfunctional but potentially viable myocardium ('stunned or hibernating myocardium') has been central to the decision-making regarding revascularisation. A number of recent studies have challenged this paradigm, questioning the role of viability testing in this population. Read More

Nihon Rinsho 2011 Sep;69 Suppl 7:138-41

Cardiovascular Division, Hyogo College of Medicine.

G Ital Cardiol (Rome) 2012 Feb;13(2):102-9

Dipartimento Cardio-Toraco-Vascolare, Universitta Vita-Salute e Istituto Scientifico, San Raffaele, Milano.

The mid- and long-term outcome of revascularization procedures is still uncertain in patients with chronic left ventricular systolic dysfunction due to coronary artery disease. The identification of dysfunctional myocardial segments with residual viability that can improve after revascularization is pivotal for further patient management. Hibernating myocardium (chronically dysfunctional but still viable tissue) can be identified by positron emission tomography and cardiac magnetic resonance and its presence and extent can predict functional recovery after revascularization. Read More

Kyobu Geka 2011 Nov;64(12):1111-3

Department of Cardiovascular Surgery, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.

An 80-year-old man was admitted to our hospital for examination of a ball thrombus incidentally found in the left ventricle (LV). Coronary angiogram revealed severe triple vessel disease and LV dysfunction. Although LV wall motion in the septum and the apex was akinetic, there were no signs of myocardial infarction. Read More

Echocardiography 2012 Mar 28;29(3):298-306. Epub 2011 Nov 28.

Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.

Background: Myocardial performance index (MPI), or Tei index, is an indicator of systolic and diastolic myocardial function. MPI increases in case of cardiac dysfunction; however, whether reversal of left ventricular dysfunction is also reflected by concomitant improvement (i.e. Read More

Eur Heart J Cardiovasc Imaging 2012 Mar 11;13(3):219-26. Epub 2011 Nov 11.

Cardiovascular Unit, Campo di Marte Hospital, Lucca, Italy.

Stunning and hibernation represent two different forms of tissue viability identifiable in acute coronary syndromes and chronic ischaemic cardiomyopathy, respectively. Functional recovery occurs spontaneously with myocardial stunning, while it generally follows revascularization in case of hibernating myocardium. Low-dose dobutamine stress echocardiography is an accurate modality for identifying myocardial stunning and provides important information on ventricular remodelling after both systemic thrombolysis and primary angioplasty. Read More