Transthoracic echocardiography
Initial assessment includes transthoracic echocardiography (TTE), where
the focus is to look for akinetic and/or dyskinetic areas within the
left anterior descending (LAD) artery myocardial territory – LV
anterior wall, anterior septum and apex. For that purpose, the apical
2-, 3- and 4 -chamber-views, respectively, are most commonly used.
Standard echocardiographic equipment is used, including harmonic imaging
with a 3.5 MHz broadband transducer, with capture of at least three
beats per view (5 beats/view in atrial fibrillation at a normal heart
rate). Additionally, contractility of the basal segments is assessed, in
order to estimate both the baseline residual function after the
reconstruction and - more importantly - the potential for improved
myocardial performance. Valvular heart disease and right ventricular
(RV) size and function are also evaluated. A contrast-enhanced
examination is not mandatory, although it further increases diagnostic
accuracy of intracardiac thrombus, which is a relative contra-indication
for the procedure. Figure 2 summarizes key aspects in TTE
screening for the LIVE procedure.