Ischaemia, hibernation, and viability

It was dogma for many years that if myocardial ischaemia persists for more than 30 minutes, necrosis will develop, resulting in myocardial infarction. The unavoidable extrapolation of that dogma suggested that chronic ischaemia, in reality, cannot exist, as it will inevitably evolve into structural changes (i.e. irreversible damage). These tenets were overturned in the early 1980s when Rahimtoola reviewed the results of coronary bypass surgery trials and identified patients with coronary artery disease and chronic left ventricular dysfunction persisting for months and even years that improved after revascularization. The rapid amelioration of myocardial function obtained by revascularization ruled out the hypothesis that the reduced function was due to histological modification of the myocardium and left the entire scientific community with the dilemma to explain and recognize hibernating myocardium.