© 1997 by European Society of Cardiology
Copyright © 1997, European Society of Cardiology
‘Myocardial hibernation’—questions and controversies1
aDepartment of Pathophysiology, University of Essen, Essen, Germany
bCentro di Fisiopatologia Cardiovascolare, Universita degli Studi di Brescia, Brescia, Italy
cThe Rayne Institute, St. Thomas' Hospital, London, UK
dHeart Lung Institute Utrecht and Interuniversity Cardiology Institute of the Netherlands, Utrecht, Netherlands
* Corresponding author. Abteilung für Pathophysiologie, Zentrum für Innere Medizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122 Essen, Germany. Tel.: +49 (201) 7234480; fax: +49 (201) 7234481.
Received 9 September 1996; accepted 5 December 1996
KEYWORDS Hibernation; Myocardial ischemia; Contractile function
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1 What is hibernation? |
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The term ‘hibernation’ has been borrowed from zoology and implies an adaptive reduction of energy expenditure through reduced activity in a situation of reduced energy supply. In the context of coronary artery disease, myocardial hibernation was originally seen as a chronic, adaptive reduction of myocardial contractile function in response to a reduction of myocardial blood flow. It was also viewed as a condition where there would be a complete recovery of contractile function upon restoration of flow. Thus, in the concept of myocardial hibernation, the observed chronic reduction of myocardial contractile function was not regarded as the result of a persistent energetic deficit, but instead as a regulatory event which acted to avoid an ongoing energy deficit and thereby maintain myocardial integrity and viability.
The concept of myocardial hibernation did not originate in the laboratory, instead it was entirely founded on clinical grounds when, in the early eighties, Rahimtoola
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2 Why is hibernation important? |
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3 What are the most pressing questions about hibernation? |
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3.1 Does hibernation necessarily require a reduction of coronary flow?
3.2 If hibernation involves a limitation of flow, does it induce ‘ischemia’?
3.3 How does hibernation develop, and does there have to be a ‘trigger’?
3.4 What is the prevalence of hibernation and why isn't it more common?
3.5 What is known about the mechanism(s) of hibernation?
3.6 What does morphology tell us about hibernation?
3.7 What is known about recovery from hibernation?
3.8 How good are current animal models of hibernation?
3.9 What is the role of pharmacology in hibernation?
3.10 Could diagnosis of hibernation avoid unnecessary heart transplantation?
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4 Where do we go from here? |
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