Evaluation of hibernating myocardium
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
- Section Editors
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
- Jeroen J Bax, MD, PhD
Jeroen J Bax, MD, PhD
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Cardiology
- Leiden University Medical Center, The Netherlands
It has become apparent that impaired left ventricular (LV) function in patients with coronary heart disease (CHD) is not always an irreversible process, but may be stunned or hibernating:
●Transient postischemic dysfunction is called "stunned" myocardium
●Chronic but potentially reversible ischemic dysfunction due to a stenosed coronary artery is called "hibernating" myocardium
From 20 to more than 50 percent of patients with chronic ischemic LV dysfunction have a significant amount of viable hibernating myocardium and therefore the potential for clinically important improvement in LV function after revascularization (figure 1) [1-4]. (See "Diagnosis and management of ischemic cardiomyopathy".)
The approach to the detection of hibernating myocardium will be reviewed here (table 1). The pathophysiology of and clinical syndromes associated with hibernation are discussed separately. (See "Pathophysiology of stunned or hibernating myocardium" and "Clinical syndromes of stunned or hibernating myocardium" and "Diagnosis and management of ischemic cardiomyopathy".)
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- EFFICACY OF IMAGING TESTS
- - Use of nitroglycerin
- - Inotropic stimulation/postextrasystolic potentiation
- Radionuclide myocardial perfusion imaging
- - End-diastolic wall thickness
- - Dobutamine echocardiography
- - TDE/strain rate imaging
- - Mitral inflow pattern
- Pooled analysis of rMPI and DE studies
- Magnetic resonance imaging
- - Wall thickness
- - Contrast-enhanced imaging
- - Kidney disease
- Newer methods
- - Electroanatomic mapping
- - Myocardial contrast echocardiography
- RECOMMENDED APPROACH
- SUMMARY AND RECOMMENDATIONS