Methods of providing image-guided transendocardial injection of a therapeutic agent into a left ventricular wall of a heart. Some methods enable injections into heart tissue under visualization. The methods may include providing an endoventricular injection catheter having integrated echocardiographic capability. The endoventricular injection catheter may have an imaging core and an injection system carried on the elongated body with the imaging core. The method may include positioning the endoventricular injection catheter into the left ventricle of the heart, which inserts the imaging core into the heart. The method may also include transmitting ultrasonic energy via the imaging core, receiving reflected ultrasonic energy at the distal end, visualizing the left ventricular wall of the heart using the imaging core, identifying infarct regions of the left ventricle, and injecting a therapeutic agent into the visualized infarcted regions of the left ventricle using the injection system.