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.