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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)