In patients with coronary artery disease (CAD) and left ventricular dysfunction, the presence of myocardial viability is a marker of clinical instability and unfavorable prognosis, unless the myocardium is reperfused. Identification of viable myocardium is therefore essential to the final outcome, particularly in cases of cardiac failure. Development of heart failure in CAD is a complex process involving recurrent ischemia, stunning, hibernation, and fibrosis. Surgical revascularization is, at present, the best therapeutic solution for myocardial hibernation. Pharmacological treatment is useful adjunct to optimize surgical results and reduce symptoms of heart failure, although no specific pharmacotherapy can be recommended at present. Contractile recovery linked to surgical revascularization is determined by completeness of revascularization, myocardial protection, postsurgical stunning, and transmural extension of the subendocardial damage...