Apoptosis in chronic hibernating myocardium: sleeping to death?

Is the 'smart heart' smart enough? Since the introduction of the term 'hibe rnating myocardium', this has been referred to as the 'smart heart', howeve r more recently several publications have suggested that cell death accompa nies the hibernation process, so that revascularisation of patients with hi bernating myocardium should be performed without delay. Other data, however , point to cellular dedifferentiation instead of cellular degeneration, whi ch means that cardiac hibernation is an adaptive mechanism capable of prese rving the myocardial Viability for a prolonged period. In an attempt to fin d an answer to the above-mentioned question, this review summarises and dis cusses the findings in this field, also giving attention to possible explan ations for the discrepant findings. (C) 2000 Elsevier Science B.V. All righ ts reserved.