An emerging concept is that the mammalian myocardium has the potential to regenerate, but that regeneration might be too inefficient to repair the extensive myocardial injury that is typical of human disease [1][2][3][4][5][6][7][8] . However, the degree to which stem cells or precursor cells contribute to the renewal of adult mammalian cardiomyocytes remains controversial. Here we report evidence that stem cells or precursor cells contribute to the replacement of adult mammalian cardiomyocytes after injury but do not contribute significantly to cardiomyocyte renewal during normal aging. We generated doubletransgenic mice to track the fate of adult cardiomyocytes in a 'pulse-chase' fashion: after a 4-OHtamoxifen pulse, green fluorescent protein (GFP) expression was induced only in cardiomyocytes, with 82.7% of cardiomyocytes expressing GFP. During normal aging up to one year, the percentage of GFP + cardiomyocytes remained unchanged, indicating that stem or precursor cells did not refresh uninjured cardiomyocytes at a significant rate during this period of time. By contrast, after myocardial infarction or pressure overload, the percentage of GFP + cardiomyocytes decreased from 82.8% in heart tissue from sham-treated mice to 67.5% in areas bordering a myocardial infarction, 76.6% in areas away from a myocardial infarction, and 75.7% in hearts subjected to pressure overload, indicating that stem cells or precursor cells had refreshed the cardiomyocytes.Despite recent enthusiasm about the idea of regenerating myocardium by using resident cardiac stem cells, fundamental questions remain unanswered. Are cardiomyocytes constantly replaced by endogenous stem or precursor cells? Does injury lead to replacement with new cardiomyocytes from a stem cell pool? It is essential to answer these questions unambiguously and quantitatively.