(Circulation. 1997;96:2920-2931.)
© 1997 American Heart Association, Inc.
Articles |
Hibernating Myocardium
An Incomplete Adaptation to Ischemia
From the Department of Cardiology (A.E., M.S., K.-D.M., R.S., C.G.), Department of Thoracic and Cardiovascular Surgery (W.-P.K.), and Department of Experimental Cardiology (W.-j.C., R.Z., S.K., B.M., W.S., J.S.), Max Planck Institute, Bad Nauheim, Germany.
Correspondence to Jutta Schaper, MD, Department of Experimental Cardiology, Max Planck Institute, Benekestr. 2, D-61231, Bad Nauheim, Germany. E-mail jschaper{at}kerckhoff.mpg.de
Background We tested the hypothesis that hibernating myocardium represents an incomplete adaptation to a reduced myocardial oxygen supply.
Methods and Results In 38 patients, areas of hibernating
myocardium were identified by angiography, multigated
radionuclide ventriculography, thallium scintigraphy with
reinjection, and low-dose dobutamine
echocardiography. Biopsies removed at cardiac
surgery showed structural degeneration characterized by a reduced
protein and mRNA expression and disorganization of the contractile and
cytoskeletal proteins myosin, actin, desmin, titin, 
-actinin, and
vinculin by electron microscopy, immunohistochemistry, and in situ
hybridization. Additionally, an increased amount of extracellular
matrix proteins resulting in a significant degree of reparative
fibrosis was present. Dedifferentiation, ie, expression of fetal
proteins, was absent. Apoptosis indicating suicidal cell death
was found by the terminal deoxynucleotidyl
transferase end-labeling method and electron microscopy. Radionuclide
ventriculography showed improvement of regional function at 3 months
postoperatively compared with preoperative values (mean values, 23.5%
and 48%, respectively), and the echocardiographic
wall-motion score index decreased from 3.4 to 1.8. The degree of
severity of the morphological changes (three stages) correlated well
with the extent of postoperative functional recovery: more advanced
clinical improvement was observed in patients with slight and moderate
morphological degeneration (stages 1 and 2), but recovery was only
partial in severe degeneration (stage 3).
Conclusions Cellular degeneration rather than adaptation is present in hibernating myocardium. The consequence is progressive diminution of the chance for complete structural and functional recovery after restoration of blood flow. The practical consequence from this study should be early revascularization in patients showing areas of hibernating myocardium.
Key Words: myocardium • ischemia • structure
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