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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 (more than 40–50%) and inward motion |
| 2 | Hypokinetic | Reduced thickening (below 40%) |
| 3 | Akinetic | Absent or negligible thickening (below 10%); scar when thin (≤6 mm) and bright |
| 4 | Dyskinetic | Paradoxical outward motion in systole, often thins |
| 5 | Aneurysmal | Diastolic deformation (bulges outward in diastole as well as systole) |
This five-point score is the one in the ASE 2020 stress echo guideline. EACVI uses four grades, as does the 2015 chamber quantification document, scoring an aneurysm as dyskinetic (4). BSE describes the grades without a numeric scale.
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