Prevalence of hibernating myocardium in patients with severely impaired ischaemic left ventricles

Objective-Severe impairment of left ventricular (LV) contraction is associa ted with an adverse prognosis in patients with ischaemic heart disease. Rev ascularisation may improve the impaired LV contraction if hibernating myoca rdium is present. The proportion of patients likely to benefit from this in tervention is unknown. Therefore, the prevalence of hibernating myocardium in patients with ischaemic heart disease and severe impairment of LV contra ction was assessed. Design-From a consecutive series of patients undergoing coronary angiograph y for the investigation of chest pain or LV impairment, all patients with i schaemic heart disease and an LV ejection fraction (LVEF) less than or equa l to 30% were identified. These patients underwent positron emission tomogr aphy (PET) to detect hibernating myocardium, identified by perfusion metabo lism mismatch. Setting-A teaching hospital directly serving 500 000 people. Results-Of a total of 301 patients, 36 had ischaemic heart disease and an L VEF less than or equal to 30%. Twenty-seven patients had PET images, while nine patients were not imaged because of emergency revascularisation (three ), loss to follow up (one), inability to give consent (four), and age < 50 years (one, ethics committee guidelines). Imaged and non-imaged groups were similar in LV impairment, demographic characteristics, and risk factor pro file. Fourteen patients (52% of the imaged or 39% of all patients with isch aemic heart disease and LVEF less than or equal to 30%) had significant are as of hibernating myocardium on PET. Conclusion-It is possible that up to 50% of patients with ischaemic heart d isease and severely impaired left ventricles have hibernating myocardium.