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[Myocardial viability. The concept of myocardial viability]
1Fédération de Cardiologie, Hôpital Henri Mondor, Créteil.
Myocardial Viability:
Certain zones of ischemic, akinetic or severely hypokinetic myocardium are capable of recovering normal contractile function. This is termed myocardial viability and occurs in two different situations: myocardial stunning and myocardial hibernation.
Myocardial Stunning:
This term designates temporary but prolonged impairment of myocardial function resulting from a brief episode of ischemia before reperfusion.
Myocardial Hibernation:
Hibernation designates prolonged but potentially reversible myocardial contractile dysfunction caused by chronic myocardial ischemia and persisting at least until blood flow is restored.
Clinical Consequences:
Theoretically reversible, myocardial stunning or hibernation can have devastating effects if they persist too long. Revascularization with angioplasty or bypass surgery is indicated.
Diagnosis:
The degree of myocardial viability in akinetic zones can be determined by assessing preserved inotropic capacity with stress echocardiography and/or evidencing metabolic activity with isotopic techniques (myocardial scintigraphy, positron emission tomography).