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.