Myocardial hibernation: restorative or preterminal sleep?

The term hibernating myocardium was first proposed by S. Rahimtoola in 1985 to describe a state of left ventricular dysfunction at rest caused by reduced coronary blood flow, which can be reversed by restoring myocardial oxygen supply or reducing myocardial oxygen demand.1 The clinical context in which it was first recognized, viz, impaired left ventricular function at rest that recovers after revascularization, was refined further when it was recognized that “fixed” defects on [Tl] perfusion images could improve after revascularization2 or with restredistribution3 or reinjection.4 To date, the molecular mechanisms underlying myocardial hibernation have remained elusive.