Functional mitral regurgitation in patients with coronary artery disease: Ischemic or Necrotic?
Figure 1. Mechanism of both necrotic and ischemic MR.
Figure 2. Example of a patient with truly ischemic MR. This patient had a normal resting echo study without MR at rest. During exercise developed global hypokinesis with LV dilation and esphericity (global remodeling) as a consequence of ischemia, leading to severe MR at the complexion of exercise that lasted 5 minutes.
Figure 3. Example of a patient with necrotic MR. This patient had an akinesia and scar in the inferolateral wall as a consequence of an old myocardial infarction, with mild MR at rest. Although there was no ischemia during exercise echocardiography, MR increased significantly.
Table. Differences between truly ischemic MR and necrotic MR
In conclusion, we propose a change in terminology for two conditions that have several differences although both of them may be present in patients with CAD.
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