From: Echocardiographic assessment of ischemic mitral regurgitation
Symmetric CIMR | Asymmetric CIMR | |
---|---|---|
Major net tethering vectors | Apical | Posterior > apical |
Tethered mitral leaflets | Anterior and posterior | Posterior |
Associated myocardial infarct pattern (and vessels) | Anterior (left anterior descending/multiple coronary arteries) | Inferoposterior (right coronary > circumflex) |
Archetype pattern of LV dysfunction | Global LV dilatation and wall motion abnormality | Inferoposterior wall motion abnormality and dilatation |
Mitral valve coaptation zone displacement | Apically | Posteriorly; pseudoprolapse of anterior leaflet over posterior leaflet |
Tethering angles | Anterior ≈ posterior | Posterior > anterior |
Tenting volume | Higher | Lower |
MR origin and direction | Central, non-eccentric | Posterior, posteriorly eccentric |
Annular dilatation | Greater | Lesser |
Annular height | Greater loss of non-planarity (“flattened”) | Less loss of height |
MR relative severity | Less severe | More severe |
Severity correlates best with | LV dilatation and sphericity | Degree of mitral valve deformation (greater tethering angles, more marked derangement of coaptation zone) |