The stunned and hibernating myocardium: a brief review.

DEFINITIONS

Stunned myocardium is viable myocardium salvaged by coronary reperfusion that exhibits prolonged postischemic dysfunction after reperfusion. Hibernating myocardium is ischemic myocardium supplied by a narrowed coronary artery in which ischemic cells remain viable but contraction is chronically depressed.

CLINICAL EVIDENCE

Stunned myocardium has been identified in the following patient groups: (1) thrombolysis or percutaneous transluminal coronary angiography (PTCA) in patients with acute evolving infarction; (2) unstable angina; (3) exercise-induced angina; (4) coronary artery spasm; (5) platelet aggregation or transient thrombosis of a coronary artery; (6) PTCA for chronic myocardial ischemia; and (7) immediately following coronary artery bypass graft (CABG). Evidence of hibernating myocardium (LV dysfunction) is found in the patient with severe coronary artery stenosis, even in asymptomatic patients at rest. Stunned myocardium returns to normal after a prolonged period of time (hours to weeks). Hibernating myocardium returns to normal function rather quickly if the cause is removed.

DIFFERENTIATION

Stunned myocardium can be differentiated from hibernating myocardium by three clinical parameters, namely, LV wall motion, myocardial perfusion, and myocardial metabolism. Stunned myocardium has abnormal wall motion that tends to normalize in response to inotropes and postextrasystolic potentiation. Perfusion is adequate and metabolism is also adequate. Hibernating myocardium also has abnormal wall motion, which normalizes after nitrates, inotropes, post extrasystolic potentiation (PESP), PTCA, or CABG. Myocardial perfusion is reduced but can be reversed with PTCA or CABG and metabolism is adequate.