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the middle muscular layer of the heart wall

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/19 06:35:01」(JST)

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In cardiology, hibernating myocardium is a state when some segments of the myocardium exhibit abnormalities of contractile function.^[1] These abnormalities can be visualised with echocardiography, cardiac magnetic resonance imaging (CMR), nuclear medicine (PET) or ventriculography. Echocardiography: A wall motion abnormality at rest which improves during a low-dose dobutamine stress test is classified as "hibernating myocardium". Low dose dobutamine stimulates contractile function and thus helps to predict functional recovery after revascularization. Cardiac magnetic resonance: The most frequently used MR contrast agents based on Gd-chelates accumulate in the extracellular space which is increased in scarred myocardium. This leads to a signal increase which can be visualised with the "late gadolinium enhancement technique". This is probably the most accurate way to visualise scarred myocardium. An alternative (or additional) technique with CMR is the use of low dose dobutamine similar to echocardiography. PET: The finding of a perfusion or metabolic mismatch between PET-FDG and PET-NH₃ is indicative of decreased metabolism. The wall of the affected segments is hypo-, a-, or dyskinetic.

The phenomenon is highly significant clinically because it usually manifests itself in the setting of chronic ischemia, that is potentially reversible by revascularisation via cardiac catheterization. The regions of myocardium are still viable and can restore its function. There develops a new steady state between myocardial blood flow (MBF) and myocardial function, MBF reduced and in consequence function is reduced too. The clinical situations where one can expect hibernating myocardium are:

chronic stable angina
unstable angina
silent ischemia
after AMI

References

^ Wijns W, Vatner SF, Camici PG (July 1998). "Hibernating myocardium". N. Engl. J. Med. 339 (3): 173–81. doi:10.1056/NEJM199807163390307. PMID 9664095.

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1. 気絶心筋または冬眠心筋の臨床的症候群 clinical syndromes of stunned or hibernating myocardium
2. 気絶心筋または冬眠心筋の病態生理 pathophysiology of stunned or hibernating myocardium
3. 冬眠心筋の評価 evaluation of hibernating myocardium
4. 冬眠心筋の評価におけるドブタミン負荷心エコー検査 dobutamine stress echocardiography in the evaluation of hibernating myocardium
5. 虚血性心筋症の診断およびマネージメント diagnosis and management of ischemic cardiomyopathy

English Journal

N-Terminal Pro B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T Levels Are Related to the Extent of Hibernating Myocardium in Patients With Ischemic Heart Failure.

Zelt JGE1, Liu PP2, Erthal F3, deKemp RA3, Wells G3, O'Meara E4, Garrard L5, Beanlands RSB1, Mielniczuk LM6.
The Canadian journal of cardiology.Can J Cardiol.2017 Nov;33(11):1478-1488. doi: 10.1016/j.cjca.2017.06.012. Epub 2017 Jun 27.
PMID 28966019

Precision Medicine and PET/Computed Tomography in Cardiovascular Disorders.

Dibble EH1, Yoo DC2.
PET clinics.PET Clin.2017 Oct;12(4):459-473. doi: 10.1016/j.cpet.2017.05.008. Epub 2017 Jul 21.
PMID 28867116

Electrocardiographic changes after successful recanalization of a chronic total coronary occlusion. A systematic review and meta-analysis.

van Dongen IM1, Elias J2, Meijborg VMF3, De Bakker JMT4, Limpens J5, Conrath CE6, Henriques JPS7.
Cardiovascular revascularization medicine : including molecular interventions.Cardiovasc Revasc Med.2017 Sep 12. pii: S1553-8389(17)30347-0. doi: 10.1016/j.carrev.2017.09.004. [Epub ahead of print]
PMID 29066338

Japanese Journal

Long-term Extracorporeal Membrane Oxygenator Support in Resuscitation for Intractable Hibernating Myocardium after Coronary Artery Bypass Grafting

MORIMOTO Yoshihisa,SUGIMOTO Takaki,SHIOZAWA Hiroko
Annals of thoracic and cardiovascular surgery 17(6), 611-613, 2011-12-01
… We report our experience of long-term extracorporeal membrane oxygenator (ECMO) support to resuscitate a 62-year-old man who had critical three-vessel disease of coronary artery complicating intractable hibernating myocardium (HM) and sudden cardiogenic shock. …
NAID 10030235572