Cardiac wall motion abnormalities

Cardiac wall motion abnormalities describe kinetic alterations in the cardiac wall motion during the cardiac cycle and have an effect on cardiac function. Cardiac wall motion abnormalities can be categorized with respect to their degree and their distribution pattern that is whether they are global or segmental and whether they can be attributed to a coronary territory or follow a non-coronary distribution ¹.

Classically cardiac wall motion can be categorized into the following types ^1,2:

• hyperkinetic or hyperkinesia
  • increased wall thickening
  • systolic inward excursion
• normokinetic or normokinesia
  • normal wall thickening
  • normal systolic inward excursion
• hypokinetic (mild/severe) or hypokinesia
  • reduced wall thickening
  • reduced systolic inward excursion
• akinetic or akinesia
  • absent wall thickening
  • reduced or absent systolic excursion
• dyskinetic or dyskinesia
  • absent wall thickening
  • systolic outward excursion or lengthening

Further cardiac wall motion abnormalities include the following ^3-5:

• tardokinesis: delayed excursion and thickening or post-systolic shortening
• paradoxical septal motion: type of dyskinesia where the septum is moving away from the left ventricular free wall during systole

Radiographic features

Left ventricular wall motion abnormalities are regularly assessed visually on echocardiography and cardiac MRI. The evaluation is primarily based on systolic wall thickening ^1,2 and as a second criterion the systolic excursion. 

The localization of segmental wall motion abnormalities is done according to the cardiac segmentation model ^6,7.

The assessment of left ventricular wall motion abnormalities can be also used for the calculation of the wall motion score index (WMSI).

Right ventricular wall motion abnormalities of the right ventricular free wall and septal wall might be evaluated if appropriate and abnormalities of the right ventricular outflow tract and the inferior right ventricular wall in specific clinical scenarios such as arrhythmogenic right ventricular cardiomyopathy or right ventricular myocardial infarction ^1,2.

Their assessment can be also used to obtain further diagnostic clues about the underlying pathology.

Diffuse or global wall-motion abnormalities might be seen in the following conditions:

• dilated cardiomyopathy
• valvular heart disease
• septic shock
• hypertrophic cardiomyopathy
• hypertensive cardiomyopathy
• cardiac amyloidosis

A coronary distribution pattern of wall-motion abnormalities can be seen in the following clinical conditions:

• myocardial ischemia due to coronary artery disease
• myocardial infarction
• coronary vasospasm

A non-coronary distribution of regional wall-motion abnormalities can have a wide variety of causes including:

• myocarditis
• Takotsubo cardiomyopathy
• cardiac tumors
• cardiac contusion
• cardiac sarcoidosis
• constrictive pericarditis
• hypertrophic cardiomyopathy
• cardiac amyloidosis

See also

• wall motion score index
• cardiac function
• cardiac strain