Surgical revascularization of hibernating myocardium: The known and the unknown

Abstract

Coronary artery disease (CAD) represents the leading cause of chronic heart failure in developed countries. Ischemic heart failure is mainly characterized by impairment of left ventricle systolic function which can result from scarring of myocardium after myocardial infarction, stunning myocardium and hibernating myocardium. Hibernating myocardium represents a cause of ischemic left ventricular dysfunction amenable to recovery after revascularization. Several viability imaging modalities are available but their role in the clinical decision-making process and the prognostic value of viability in patients undergoing revascularization are still debated. When available, cardiac magnetic resonance or positron emission tomography should be preferred over the others as they show higher performance in terms of sensitivity and higher spatial resolution. Several observational studies have supported a positive prognostic value to the presence of viable myocardium for patients undergoing revascularization. This was not confirmed in randomized clinical trials. This lack of evidence does not support a precise role of viability assessment in the clinical decision-making process, and therefore, myocardial viability should be only one of the several factors considered in the clinical decision-making process.