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17-segment model and regional wall motion scoring on echo
Regional wall motion assessment divides the left ventricle into 17 segments (AHA/ASE model) and grades each one by how much it thickens and moves inward in systole.
The 17 segments
Basal (1–6) and mid (7–12): anterior, anteroseptal, inferoseptal, inferior, inferolateral, anterolateral.
Apical (13–16): anterior, septal, inferior, lateral.
17: the apical cap.
On the bullseye the anterior wall is at the top, the septum on the left, the inferior wall at the bottom and the lateral wall on the right, as if looking from the apex. Switch to Diagrams to see the same segments on the apical 4-, 2- and 3-chamber views and the basal and mid short-axis views.
Which view shows which wall
| View | Walls (left → right on screen) |
|---|---|
| Apical 4-chamber | Inferoseptum · apical septal · apex · apical lateral · anterolateral |
| Apical 2-chamber | Inferior · apical inferior · apex · apical anterior · anterior |
| Apical 3-chamber | Inferolateral · apical lateral · apex · apical anterior · anteroseptum |
| PLAX | Anteroseptum (top) · inferolateral wall (bottom); the apex is usually not seen |
| PSAX (basal, mid) | Full ring: anterior (top), septum (left), inferior (bottom), lateral (right) |
The wall motion score
| Score | Grade | Definition |
|---|---|---|
| 1 | Normal | Normal (or increased) thickening and inward motion |
| 2 | Hypokinetic | Reduced thickening |
| 3 | Akinetic | Absent or negligible thickening (scar when thin, <6 mm, and bright) |
| 4 | Dyskinetic | Moves outward in systole, often thins |
| 5 | Aneurysmal | Diastolic deformation (bulges outward in diastole as well as systole) |
The ASE/EACVI 2015 recommendations use a four-point score (1–4) and describe an aneurysm separately; the older five-point scale, with 5 = aneurysmal, is still widely used and is the one this simulator scores.
Thickening, not motion
The most common error is grading by endocardial motion. An akinetic segment is pulled inward by its normal neighbours (tethering) and appears to move, but it does not thicken. The reverse also occurs: in LBBB, RV pacing, after cardiac surgery and with RV overload the septum moves abnormally while it thickens normally, and is graded normal.
Coronary territories
LAD: anterior, anteroseptal and apical segments (1, 2, 7, 8, 13, 14, 17). RCA: inferior and basal/mid inferoseptal (3, 4, 9, 10, 15). LCx: inferolateral and anterolateral (5, 6, 11, 12, 16). The apical cap and apical inferior and lateral segments are variable: dominance and a wrap-around LAD shift these boundaries. Abnormalities that run circumferentially across territories suggest Takotsubo or a non-coronary cause.
Practise wall motion scoring →Pathology guides