The concept of myocardial hibernation was first proposed in the 1980s, and cardiologists and cardiac surgeons have become familiar with the possibility of improving ventricular function by restoring myocardial blood flow to dysfunctional but viable areas of myocardium subtended by a stenotic coronary artery. Despite this, coronary revascularisation has not been widely adopted as a strategy to treat patients with ischaemic heart failure. Indeed it seems likely that most cases of “ischaemic” heart failure are never investigated with a view to revascularisation. Are cardiologists and cardiac surgeons underinvestigating and treating this group of patients or are they properly directing scarce resources away from an intellectually attractive but expensive and high risk management strategy without proved benefit? A number of important questions remain to be answered before revascularisation to improve ventricular function can be considered as a standard treatment strategy for these patients.

• What proportion of patients with heart failure caused by coronary artery disease have potentially recoverable left ventricular dysfunction?

• How accurate are the techniques currently used to differentiate hibernating myocardium from irreversibly damaged tissue?

• How much viable myocardium is required for revascularisation to confer clinical benefit?

• Can coronary revascularisation be performed at acceptable risk in patients with poor ventricular function but viable myocardium?

• Most importantly, does revascularisation of hibernating myocardium result in sustained symptomatic and functional improvement as well as improvement in prognosis compared to continued optimal medical treatment?