Hibernation or repetitive stunning – does it matter? The basic perspective

The long-lasting controversy on whether the contractile dysfunction observed in patients with coronary artery disease reflects hibernation – that is, a regulatory adaptation to persistent ischemia – or stunning – that is, an accumulation of reversible damage due to repeated periods of ischemia/reperfusion – is resolved. The perfect adaptation to persistent ischemia as seen experimentally can not be maintained for more than several hours (arguing against pure hibernation), but dysfunctional myocardium does not only display signs of damage but also an up-regulation of cardioprotective genes (arguing against pure stunning). Thus, as is often the case, both sides were wrong and right. Heart Metab. 2009;42:32–33.