Patient screening
Potential candidates for LIVE therapy present with symptomatic HF (NYHA
class \(\geq\) II) due to cardiac dysfunction caused by a previous
anterior MI, resulting in increased LV systolic volume and in a
discrete, contiguous, acontractile, (akinetic and/or dyskinetic) scar
located in the antero-septal, apical region of the left ventricle. The
myocardial scar needs to be at least 50% transmural to provide
sufficient support and resistance to the plicating anchors. Alternative
myocardial scar locations can also be considered for treatment, as
lateral wall scar. Furthermore, patients with purely dyskinetic LV
anterior or antero-apical walls, that could be described as classic or
“true” LV aneurysms are good candidates for LIVE therapy. There should
be sufficient scar maturation or fibrotic tensile strength developed to
provide adequate support (and prevent “pull through” and wall lesion)
for the anchors. As such, the initial ischemic myocardial event should
have taken place at least 90 days before the intervention. After
appropriate clinical assessment, imaging is essential to assess
indication, eligibility and potential contra-indications for the therapy
(Table 1 – Multi-modality imaging overview; Table 2– Exclusion criteria). This stepwise approach is described below.