Myocardial hibernation: a noninvasive physician's point of view.

In a large subset of patients with coronary artery disease and left ventricular (LV) dysfunction. LV performance is reduced on the basis of regionally ischemic or hibernating myocardium rather than irreversibly infarcted myocardium. The detection of reversibly dysfunctional myocardium is clinically relevant, as regional and global LV function in such patients may improve substantially after revascularization. Noninvasive imaging methods to assess myocardial metabolic activity, membrane integrity, and inotropic reserve are ideally suited for this assessment. Among these are the unique potential of nuclear cardiology techniques to distinguish viable regions on the basis of perfusion, cell membrane integrity, and metabolic activity and the ability of dobutamine echocardiography to assess regional inotropic reserve. Contrast-enhanced magnetic resonance imaging has also emerged as important method for viability. assessment. Patients with LV dysfunction and extensive regions of hibernating myocarduim appear to have the potential not only for improved left ventricular function after revascularization, but also for improved symptoms and improved survial. This, assessing myocardial viability may provide important information regarding the selection of patients with LV dysfunction for myocardial revascularization procedures.