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Table 2 Characteristics of symmetric versus asymmetric CIMR tethering phenotypes

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)