Wall Motion Abnormalites
Objectives
- Defining
- Segments and territories
- ...In coronary artery disease
- ...In the absence of coronary artery disease
Definition:
Wall Motion Abnormalities
Normal wall motion
- Endocardial motion of the myocardial segment
- Can be overestimated by passive dragging
- Wall Thickening -% thickening estimate
- Less affected by nearby wall motion, dragging and shape changes
Scoring System
| Score | Explanation |
|---|---|
| Normo-hyperkinetic | |
| Hypokinetic | Decreased thickening |
| Akinetic | Negligible or absent thickening |
| Dyskinetic | Systolic thinning or stretching |
| Dyskinetic - aneurysmal | Focal dilation or thinning with akinesia or dyskinetic systolic motion |
Grading Wall Motion
Territories
17 (16) Segment Model
J Am Soc Echocardiogr 2015;28:1-39.
Vessel Territories
Vessel Territories
J Am Soc Echocardiogr 2015;28:1-39.
In coronary artery disease
Anterior STEMI
"Anterior septum and anterior hypokinesis to akinesis at basal and mid LV levels. Apex is hypokinetic to
akinetic."
Anterior STEMI
Inferior STEMI
Inferior STEMI
Anterior, anteriorseptal and apical
Anterior, anteroseptal and apical akinesis
Without coronary artery disease
Cardiomyopathies
| Cardiomyopathy | Explanation |
|---|---|
| Myocarditis | Segmental or non-segmental wall motion abnormalities |
| Sarcoidosis | Wall motion abnormalities in a non-coronary distribution |
| Stress induced cardiomyopathy (classical) |
Apical balooning Hyperdynamic base, outside of a single vessel territory |
Stress Induced Cardiomyopathy
cardioguide.com
Other distinct movements to comment on...
- Septal bounce
- Lateral apical movement during systole
Summary
- Classify regional wall motion abnormalities
- Use of 17-segment model
- Consider if regional wall motions fits vessel distribution