Hibernating viable myocardium

This 52-years old man had acute chest pain. His ECG showed antero-septal ischemia and his ejection fraction was 35% on the echocardiogram with anterior wall hypokinesia. He underwent an angiogram, which showed severe multi-vessel disease.  A cardiac MRI was performed to rule out infarction and assess viability

The cine images showed moderate to severe hypokinesia of the anterior and lateral walls. There was no abnormal delayed hyperenhancement i.e. evidence of infarction (Figs. 1-3). This is a classic situation suggesting stunning or hibernation (since it was unclear as to how long the patient had ischemia and a reduced ejection fraction).