title: Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern.
abstract: Although the mechanism of ischemic mitral regurgitation (MR) is understood, the echocardiographic picture of ischemic MR is not homogeneous. Ninety-two consecutive patients with chronic ischemic MR due to restricted motion were divided into two groups according to tethering pattern: the asymmetric group with predominant posterior tethering of both leaflets (54 patients) and the symmetric one with predominant apical tethering of both leaflets (38 patients). The mitral deformation indexes, LV global (volume, function and sphericity) and local (papillary muscle displacements and regional wall motion score index) remodeling were evaluated. All indexes of global LV remodeling were significantly higher in the symmetric than asymmetric group (all p < 0.0001), such as the posterior and lateral displacement of the anterior papillary muscle (both p < 0.04), the papillary muscle separation and the anterior papillary muscle wall motion index (both p < 0.0001). The origin as well as the direction of the jet was central in all patients of the symmetric group. In the asymmetric one the origin was central in 78% of the cases and arising from the medial commissure in 22% whereas the jet direction was posterior and central in 83% and 17% of patients, respectively. Therefore, it is possible to distinguish at least two subgroups of patients with ischemic MR due to restricted motion on the basis of tethering pattern, different degree of local and global LV remodeling and characteristics of the regurgitant jet.
authors.affiliation: Division of Non-Invasive Cardiology, Department of Cardiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milano, Italy. agricola.eustachio@hsr.it
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Michele
authors.initials: M
authors.lastname: Oppizzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
authors.forename: Giulio
authors.initials: G
authors.lastname: Melisurgo
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015203:Reproducibility of Results; D020257:Ventricular Remodeling