Apoptosis in chronic hibernating myocardium: sleeping to death?

Is the 'smart heart' smart enough? Since the introduction of the term 'hibernating myocardium', this has been referred to as the 'smart heart', however more recently several publications have suggested that cell death accompanies the hibernation process, so that revascularisation of patients with hibernating myocardium should be performed without delay. Other data, however, point to cellular dedifferentiation instead of cellular degeneration, which means that cardiac hibernation is an adaptive mechanism capable of preserving the myocardial viability for a prolonged period. In an attempt to find an answer to the above-mentioned question, this review summarises and discusses the findings in this field, also giving attention to possible explanations for the discrepant findings.