ASE Standards for Wall Segments

The American Society for Echocardiography (ASE) has issued standards for the break down of echocardiograms of the human heart. Transesophageal echocardiography (TEE) is done to create a sonogram of the heart. The wall segment map provides a direct reference to other medical professionals for where heart wall motion abnormalities were observed.

Reasons for Monitoring

• Cardiac wall motion may be monitored using TEE by doctors after a heart attack, chest infection or suspected heart arrhythmia. Heart wall motion is also monitored in cases of mitral valve prolapse, congenital heart defects and injury to the heart muscle. Ventricle muscle motion of the wall segments in these cases is rated on a five-point scale by the ASE to create a standard reference for understanding the severity of the observed behavior along with abbreviations to simplify identification of areas on echocardiograms.

Abbreviations

• ASE created standard abbreviations for understanding of medical charts as they are passed from sonogram technician to cardiologist or primary care doctor. ASE standards abbreviate left ventricle to LV and right ventricle to RV. The major blood vessels to and from the heart also have standard abbreviations such as circumflex coronary artery (CIRC), right coronary artery (RCA) and left anterior descending artery (LAD). The ventricular septum is shortened to VS. The right ventricular free wall is shortened to RVFW. This allows for doctors to quickly denote the abbreviation of observed areas with problems and their score on the wall segment motion scale for understanding the whole heart's functioning.

Wall Segment Motion Scale

• A high wall motion score indicates poor heart health.

  A score of one is given for normal heart wall motion. Hypoknetic function is assigned a level two for mild and level three for severe. Dyskinesis or akinetic heart wall motion is assigned a four. Severely deformed wall motion is given a score of five. According to "Clinical Diagnostic Ultrasound" by Grant Baxter, Paul Allan and Patricia Morley: "Wall motion is quantified as a wall motion score index by adding the segment scores and dividing by the number of segments." Global wall motion score is found by the wall motion scores for all 16 sections of the heart and then dividing by 16.

Wall Motion Model

• The ASE standard on cardiographic wall segments has 16 segments. The apical cap can be treated as a 17th segment. The ASE model divides the left ventricle into basal, mid and apical levels. According to "Perioperative Transesophageal Echocardiography," "The basal and mid levels are each subdivided into six segments, and the apical level is divided into four segments." The wall motion model is mirrored for each side of the heart.

Related Standards

• The ASE subcommittee on Quantitation of Two Dimensional Echocardiograms created ASE standards for wall segments. These standards were developed in conjunction with the European Society of Cardiology. ASE standards for wall segments are shared by the Society for Cardiovascular Anesthesiologists (SCA).