Relevance of apoptosis in influencing recovery of hibernating myocardium

Annalisa Angelini, Giuseppe Maiolino, Giovanni La Canna, Claudio Ceconi, Fiorella Calabrese, Elena Pettenazzo, Marialuisa Valente, Ottavio Alfieri, Gaetano Thiene, Roberto Ferrari

Research output: Contribution to journalArticle


Background: Hibernating myocardium (HM) is viable but dysfunctional myocardium which can recover following revascularization. Myocyte necrosis is virtually absent in HM; however, cellular loss may take place by apoptosis, although this is controversial. Aim: To assess the presence of apoptosis and its relevance in HM. Methods: During coronary artery by-pass surgery (CABG), 21 patients underwent transmural biopsy in the dysfunctional left anterior descending artery tributary area of the left ventricle (LV), with kinetic recovery at follow-up, thus fulfilling the HM criteria. All patients underwent echocardiographic follow-up at 12 months. All biopsies were evaluated by light microscopy, electron microscopy (EM), and molecular analysis. Results: All biopsies were structurally altered, showing increased fibrosis and myocytes with variable size. Myocyte dedifferentiation was not detected by immunohistochemistry or EM. On stepwise linear regression, 1 year LVEF was predicted by the apoptotic index (β = - 0.973, p = 0.002), the normotrophic cell percentage (β = 0.449, p = 0.038), and mean fibrosis (β = - 0.412, p = 0.51). Conclusions: Our biopsy study detected a wide range of morphological substrate heterogeneity in HM with degenerative features. We have demonstrated for the first time in humans that myocyte apoptosis is an important phenomenon in HM, negatively influencing LV functional recovery after CABG.

Original languageEnglish
Pages (from-to)377-383
Number of pages7
JournalEuropean Journal of Heart Failure
Issue number4
Publication statusPublished - Apr 2007


  • Apoptosis
  • Hibernating myocardium
  • Pathology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Angelini, A., Maiolino, G., La Canna, G., Ceconi, C., Calabrese, F., Pettenazzo, E., Valente, M., Alfieri, O., Thiene, G., & Ferrari, R. (2007). Relevance of apoptosis in influencing recovery of hibernating myocardium. European Journal of Heart Failure, 9(4), 377-383.