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LV Torsion: A Powerful Marker of Systolic Function Definition Left ventricular (LV) torsion (or twist) refers to the wringing motion of the heart during systole, apical counterclockwise rotation vs basal clockwise rotation. It results from the unique helical arrangement of subendocardial and subepicardial fibers. How is it measured? Using speckle-tracking echocardiography, torsion is calculated as the net difference in rotation between apex and base, typically in degrees. We can also measure the rate of rotation (deg/sec), offering further functional insight. Why does it matter? Torsion reflects myocardial efficiency and contractile function. It is sensitive to: 🔵 Early systolic dysfunction (even with preserved EF) 🔵 Myocardial ischemia and infarction 🔵 Cardiomyopathies (HCM, DCM) 🔵 Heart failure (including HFpEF) Reference: Modified from Bulwer BE, Solomon SD. In: Atlas of Echocardiography, 2nd ed. Springer; 2009:63.