The severity, extent and localization of regional wall motion abnormalities (RWMA) were quantitatively assessed with apical biplane two-dimensional echocardiography (2DE) using a fixed-axis system, ten-segment division area method in 56 patients with old myocardial infarction (OMI). RWMA were found to be more severe in the anterior wall MI (AWMI) group than in the inferoposterior wall MI (IWMI) group and most severe in the extensive AWMI with ventricular aneurysm (EAWMI with VA) group; the extent of RWMA was smallest in the IWMI group, significantly larger in the AWMI group, and largest in the EAWMI with VA group. The location of the RWMA segments showed group-specific tendencies. For example, both coronal and sagittal apices were much more frequently involved in both the EAWMI with VA and the AWMI groups than in the IWMI group (100%, 87% and 0%, respectively, all P < 0.001). The results demonstrated that quantitative analysis of RWMA using 2DE in cases of MI is accurate and feasible.