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Objective To discuss the different mechanisms of mitral regurgitation(MR) by comparison of the complex mitral geometry in patients with anterior myocardial infarction(MI) and patients with inferior MI.Methods 33 consecutive patients with prior inferior MI(inferior MI group),61 consecutive patients with anterior MI(anterior MI group) and 22 subjects with normal echocardiograms(control group) were enrolled in our research.Based on systemic echocardiography,left ventricular(LV) volume,mitral annular area and MR fraction were quantified by 2D and color Doppler flow imaging.PM tethering distances were determined by measurement of interpapillary distances to the mitral valve annulus in apical four-chamber and corss-sectional two-chamber views.Results Significant MR(MR fraction >20%) was observed in 12 of the 33 with inferior MI and 7 of the 61 with anterior MI.In inferior MI patients complicated with MR,tethering distance was significantly longer in medial compared to lateral PM [(42.6±4.9) mm vs.(36.1±1.7) mm,P<0.01)],demonstrating asymmetric medial PM displacement.Patients with MR due to anterior MI had comparable increases in both PM tethering distances [(41.0±2.4) vs.(41.4±1.8) mm,P>0.05],demonstrating symmetric bilateral PM displacement.Multiple regression analysis revealed that posteromedial papillary tethering distance and the sum of bilateral tethering distances were the independent influence factors contributing to inferior MI and anterior MI complicated with MR,respectively.Conclusion Patients with ischemic MR complicated with inferior MI have asymmetrically predominant medial PM displacement,while those with ischemic MR during anterior MI have symmetric bilateral PM displacements.

Different Mechanisms of Ischemic Mitral Regurgitation in Patients With Inferior and Anterior Myocardial Infarction