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Am J Physiol Heart Circ Physiol (November 24, 2004). doi:10.1152/ajpheart.01109.2004
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Submitted on November 2, 2004
Accepted on November 18, 2004

Myocardial Hibernation - a delicate balance

Gerd Heusch1*, Rainer Schulz1, and Shahbudin H. Rahimtoola2

1 Institute fur Pathophysiology, Universitatsklinikum Essen, Essen, Germany
2 USC Medical Center, University of Southern California, Los Angeles, CA, USA

* To whom correspondence should be addressed. E-mail: gerd.heusch{at}uni-essen.de.

The pathophysiology of myocardial hibernation is characterized as a situation of reduced regional contractile function distal to a coronary artery stenosis which recovers after removal of the coronary stenosis. A subacute "downregulation" of contractile function in response to reduced regional myocardial blood flow exists which normalizes regional energy and substrate metabolism, but does not persist for more than 12-24 hours. Chronic hibernation develops in response to one or more episodes of myocardial ischemia/reperfusion, possibly progressing from repetitive stunning with normal blood flow to hibernation with reduced blood flow. An upregulation of a protective gene program is seen in hibernating myocardium, putting it into the context of preconditioning. The morphology of hibernating myocardium is characterized by both adaptive and degenerative features.




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