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[Revascularization of the hibernated myocardium: a clinical problem still unsolved]

Enrico Ammirati1, Valentina Guida, Ornella E Rimoldi

  • 1Dipartimento Cardio-Toraco-Vascolare, Universitta Vita-Salute e Istituto Scientifico, San Raffaele, Milano.

Giornale Italiano Di Cardiologia (2006)
|February 11, 2012
PubMed

Insights

Identifying hibernating myocardium is key for revascularization success in heart failure patients. This review examines evidence and proposes future trials for improving outcomes in ischemic left ventricular dysfunction.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Context:

  • Chronic left ventricular systolic dysfunction in coronary artery disease presents uncertain outcomes after revascularization.
  • Identifying viable but dysfunctional myocardium (hibernating myocardium) is crucial for predicting recovery.
  • Advances in medical therapy and devices have improved prognosis for heart failure patients.

Purpose:

  • To review pathophysiological mechanisms, clinical studies, and meta-analyses on revascularization for ischemic left ventricular dysfunction.
  • To discuss the role of hibernating myocardium in predicting functional recovery post-revascularization.
  • To propose a future randomized trial assessing revascularization's prognostic impact on hibernating myocardium.

Summary:

  • The mid- to long-term outcomes of revascularization in patients with chronic left ventricular systolic dysfunction due to coronary artery disease remain uncertain.
  • Hibernating myocardium, identified by advanced imaging, can predict functional recovery after revascularization.
  • The STICH trial assessed revascularization's prognostic benefit in addition to optimal medical therapy for ischemic left ventricular dysfunction.

Impact:

  • Understanding hibernating myocardium aids in selecting appropriate patients for revascularization, potentially improving functional recovery.
  • This review synthesizes four decades of research, informing clinical decision-making and future research directions.
  • A proposed trial aims to definitively assess the prognostic value of revascularizing hibernating myocardium.

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