LEFT-VENTRICULAR DYSFUNCTION DUE TO STUNNING AND HIBERNATION IN PATIENTS

Left ventricular dysfunction is in most cases the consequence of myoca rdial ischemia. It may occur transiently during an attack of angina an d usually it is reversible. It may persist over hours or even days in patients after an episode of ischemia followed by reperfusion, leading to the so-called condition of stunning. In patients with persistent l imitation of coronary flow, left ventricular dysfunction may be presen t over months and years, or indefinitely in subjects with fibrosis, sc ar formation, and remodeling after myocardial infarction. However, chr onic left ventricular dysfunction does not mean permanent or irreversi ble cell damage. Hypoperfused myocytes can remain viable but akinetic. This type of dysfunction has been called hibernating myocardium. The dysfunction due to hibernation can be partially or completely restored to normal by reperfusion. It is, therefore, important to clinically r ecognize a hibernating myocardium. In the present article we evaluate stunning and hibernation with respect to clinical decision making and, when possible, we refer to our ongoing clinical experience.