Which left ventricular regions are classified as hypokinetic?

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Last updated: November 1, 2026 • View editorial policy

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Left Ventricular Regional Wall Motion Segments in Hypokinesia

Any of the 17 standardized left ventricular segments can be classified as hypokinetic when they demonstrate reduced wall thickening during systolic contraction. 1

The 17-Segment Model

According to ACC/AHA cardiac imaging standards, the left ventricle is divided into 17 segments that can each be independently assessed for wall motion abnormalities, including hypokinesia 1:

Basal Level (Segments 1-6):

  • Segment 1: Basal anterior
  • Segment 2: Basal anteroseptal
  • Segment 3: Basal inferoseptal
  • Segment 4: Basal inferior
  • Segment 5: Basal inferolateral
  • Segment 6: Basal anterolateral

Mid-Ventricular Level (Segments 7-12):

  • Segment 7: Mid anterior
  • Segment 8: Mid anteroseptal
  • Segment 9: Mid inferoseptal
  • Segment 10: Mid inferior
  • Segment 11: Mid inferolateral
  • Segment 12: Mid anterolateral

Apical Level (Segments 13-17):

  • Segment 13: Apical anterior
  • Segment 14: Apical septal
  • Segment 15: Apical inferior
  • Segment 16: Apical lateral
  • Segment 17: Apex (apical cap)

Definition of Hypokinesia

Hypokinesia is defined as reduced wall thickening during systole - the segment contracts but with diminished amplitude compared to normal segments 1, 2. This is distinct from:

  • Normal/normokinetic: Full wall thickening
  • Akinetic: Absent or negligible thickening
  • Dyskinetic: Paradoxical systolic thinning or stretching

Clinical Application

The 17-segment model is recommended for SPECT, echocardiography, and cardiac MRI 1. Each segment should be evaluated individually across multiple imaging views 2. A wall motion score can be assigned: 1 (normal/hyperkinetic), 2 (hypokinetic), 3 (akinetic), or 4 (dyskinetic) 2.

Important Clinical Considerations:

  • Focus on wall thickening, not just endocardial motion, as motion can result from tethering by adjacent segments or overall cardiac displacement 2
  • Hypokinetic segments can occur in any location depending on the coronary territory affected or underlying cardiomyopathy pattern
  • Research shows that even segments appearing normokinetic in coronary artery disease may have subclinical dysfunction compared to truly healthy myocardium 3
  • The anterior wall and apex are particularly important to assess, as anterior wall hypokinesia has higher diagnostic accuracy for coronary disease 4

An optional 10-segment model exists for left ventriculography, but the 17-segment model is the current standard for comprehensive regional wall motion assessment 1.

References

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