Aim: To clarify the different configuration of the mitral annulus (MA) in the two different types of ischemic mitral regurgitation (IMR) with combined use of real-time 3D echocardiography and 3D computer software for 3D reconstruction. Methods: Sixteen IMR patients and 8 normal controls underwent real-time 3D echocardiography. IMR patients were divided into two groups according to the contributing LV geometry; regional IMR (n=8) followed by localized posterior wall remodeling due to posterior infarction, global IMR (n=8) followed by global LV remodeling due to severe LV systolic dysfunction. MR severity was quantified by regurgitant volume (RV) using PISA method. The 3D shape of the mitral annulus was reconstructed with 3D computer software and the MA area (MAA) was then automatically calculated during early and late systole. MAA was corrected (c) by the height of each patient for the comparison. Non-planarity of the annulus was estimated via the non-planar angle (NPA) between the 2 vectors from the two hinge-points of the annulus in the antero-posterior (AP) plane to the center of the axis connecting the two commissures in the commissure-commissure (CC) plane.Results: LV chamber (LVEDD: 212짹45 vs. 115짹21 ml, p<0.01) was significantly larger and systolic function (EF: 28짹4 vs.42짹8 %, p<0.01) was significantly lower in global IMR than regional IMR. There was no significant difference of RV between global and regional IMR (33짹20 vs. 31짹15 ml, p>0.05). cMAA and NPA were significantly (p<0.05) larger in both IMR groups compared to normal controls. cMAA was enlarged more (6.6짹0.9 vs. 5.6짹0.5cm짼/m, p < 0.05) in global IMR than in regional IMR. Fractional change of MAA from early to late systole was significantly (p < 0.05) larger in regional IMR than in global IMR. Conclusion:The 'saddle shape' of the mitral annulus was significantly more enlarged and flattened in IMR patients than normal controls. It was further enlarged in global IMR compared to regional IMR despite no significant difference of MR severity. Systolic change of the MA was rather preserved in regional IMR compared to global IMR