Echocardiographic Assessment of Chronic Ischemic Mitral Regurgitation (CIMR)

Abstract

The concept of ischemic mitral regurgitation must be clarified according to mechanisms as well as by acuity. In acute coronary syndromes and early in the course of myocardial infarction, MR may occur due to PM ischemia or rupture due to infarction, ischemic LV dilation, and/or increased LV diastolic pressures. Chronic ischemic mitral regurgitation (CIMR), also known as "ischemic chronic secondary MR" by new guidelines, is the most frequent clinical scenario for MR arising post infarct. CIMR is MR caused by geometric changes of the LV and distortion of normal spatial relationships of the mitral apparatus, all secondary to remodelling from ischemic heart disease.   The main concerns when evaluating MR by echocardiography include severity, defining the pathology in the mitral valve apparatus's components, the overall mechanism of MR, and, depending on it, considering treatment options of MR.