What is hypokinesia in an echo report?

In an echocardiogram report, hypokinesia refers to a localized or global decrease in the inward movement and thickening of the heart muscle wall during systole. Simply put, a specific segment of the myocardium is contracting, but noticeably weaker than normal.

The Clinical Context

In the standard 16- or 17-segment model of the left ventricle used in echocardiography, wall motion is graded on a specific index to calculate the Wall Motion Score Index (WMSI):

• 1 = Normal: Normal inward motion and myocardial thickening (>30%).
• 2 = Hypokinesia: Reduced inward motion and thickening (<30%).
• 3 = Akinesia: Absence of inward motion and thickening (no movement).
• 4 = Dyskinesia: Paradoxical outward movement during systole (often seen with ventricular aneurysms).

Common Etiologies

When a segment is flagged as hypokinetic, the primary concern is usually a mismatch between myocardial oxygen supply and demand. The underlying mechanisms typically include:

• Acute Ischemia: An active, immediate reduction in blood flow (e.g., during acute coronary syndrome). The regional wall motion abnormality (RWMA) will map directly to the affected coronary territory.
• Myocardial Stunning: Temporary contractile dysfunction following a brief episode of severe ischemia. The muscle remains hypokinetic for a period even after normal blood flow has been fully restored.
• Myocardial Hibernation: A chronic downregulation of contractile function due to prolonged, severe coronary artery disease. The tissue is viable but “sleeping” to conserve energy, and function is potentially reversible with revascularization.
• Prior Infarction: Evolving scar tissue where some viable muscle fibers remain. (Dense, established transmural scars usually present as akinesia).
• Non-Ischemic Causes: Conditions like myocarditis, Takotsubo cardiomyopathy, or other cardiomyopathies can cause regional or global hypokinesia that often does not follow a specific epicardial coronary distribution.