Document Type: Original Research


1 PhD, Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 MD, Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 PhD, Biomedical Informatics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: The aim of the present study was to evaluate how left ventricular twist and torsion are associated with sex between sex groups of the same age.
Materials and Methods: In this analytical study, twenty one healthy subjects were scanned in left ventricle basal and apical short axis views to run the block matching algorithm; instantaneous changes in the base and apex rotation angels were estimated by this algorithm and then instantaneous changes of the twist and torsion were calculated over the cardiac cycle.
Results: The rotation amount between the consecutive frames in basal and apical levels was extracted from short axis views by tracking the speckle pattern of images. The maximum basal rotation angle for men and women were -6.94°±1.84 and 9.85°±2.36 degrees (p-value = 0.054), respectively. Apex maximum rotation for men was -8.89°±2.04 and for women was 12.18°±2.33 (p-value < 0.05). The peak of twist angle for men and women was 16.78 ± 1.83 and 20.95± 2.09 degrees (p-value < 0.05), respectively. In men and women groups, the peak of calculated torsion angle was 5.49°±1.04 and 7.12± 1.38 degrees (p-value < 0.05), respectively.
Conclusion: The conclusion is that although torsion is an efficient parameter for left ventricle function assessment, because it can take in account the heart diameter and length, statistic evaluation of the results shows that among men and women LV mechanical parameters are significantly different. This study was mainly ascribed to the dependency of the torsion and twist on patient sex.


  1. Kendoul F, Fantoni I, Nonami K. Optic Flow-Based Vision System for Autonomous 3D Localization and Control of Small Aerial Vehicles. Unmanned Aerial Vehicles: Embedded Control. 2010:209-36.
  2. STONE W. Starling’s Principles of Human Physiology. American Journal of Physical Medicine & Rehabilitation. 1953;32:390.
  3. Gunther R. Early Science in Oxford. Oxford: Oxford University Press. 1920.
  4. Geleijnse ML, Van Dalen BM. Let’s twist. European Heart Journal-Cardiovascular Imaging. 2008.
  5. Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre architecture in man. Br Heart J. 1981;45:248-63. PubMed PMID: 7008815. PubMed PMCID: 482521.
  6. Henson RE, Song SK, Pastorek JS, Ackerman JJ, Lorenz CH. Left ventricular torsion is equal in mice and humans. Am J Physiol Heart Circ Physiol. 2000;278:H1117-23. PubMed PMID: 10749705.
  7. Nakatani S. Left ventricular rotation and twist: why should we learn? J Cardiovasc Ultrasound. 2011;19:1-6. PubMed PMID: 21519484. PubMed PMCID: 3079077.
  8. Bertini M, Sengupta PP, Nucifora G, Delgado V, Ng AC, Marsan NA, et al. Role of left ventricular twist mechanics in the assessment of cardiac dyssynchrony in heart failure. JACC Cardiovasc Imaging. 2009;2:1425-35. PubMed PMID: 20083079.
  9. Torrent-Guasp F, Kocica MJ, Corno AF, Komeda M, Carreras-Costa F, Flotats A, et al. Towards new understanding of the heart structure and function. Eur J Cardiothorac Surg. 2005;27:191-201. PubMed PMID: 15691670.
  10. Beladan CC, Calin A, Rosca M, Ginghina C, Popescu BA. Left ventricular twist dynamics: principles and applications. Heart. 2014;100:731-40. PubMed PMID: 23661636.
  11. Notomi Y, Martin-Miklovic MG, Oryszak SJ, Shiota T, Deserranno D, Popovic ZB, et al. Enhanced ventricular untwisting during exercise: a mechanistic manifestation of elastic recoil described by Doppler tissue imaging. Circulation. 2006;113:2524-33. PubMed PMID: 16717149.
  12. Notomi Y, Srinath G, Shiota T, Martin-Miklovic MG, Beachler L, Howell K, et al. Maturational and adaptive modulation of left ventricular torsional biomechanics: Doppler tissue imaging observation from infancy to adulthood. Circulation. 2006;113:2534-41. PubMed PMID: 16717154.
  13. Yilmaz S, Kiliç H, Demirtas S, Çakar M, Edis L, Vatan M, et al. Age-related changes in left ventrikuler torsion. Atherosclerosis. 2015;241:e214-e5.
  14. Burns AT, McDonald IG, Thomas JD, Macisaac A, Prior D. Doin’ the twist: new tools for an old concept of myocardial function. Heart. 2008;94:978-83. PubMed PMID: 18625792.
  15. Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M, et al. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr. 2004;17:1021-9. PubMed PMID: 15452466.
  16. Sengupta PP, Khandheria BK, Narula J. Twist and untwist mechanics of the left ventricle. Heart Fail Clin. 2008;4:315-24. PubMed PMID: 18598983.
  17. Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, et al. Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography. Circulation. 1980;62:212-7. PubMed PMID: 7397962.
  18. Luo X, Cao T, Li Z, Duan Y. A preliminary study on the evaluation of relationship between left ventricular torsion and cardiac cycle phase by two-dimensional ultrasound speckle tracking imaging. Int J Cardiovasc Imaging. 2009;25:559-68. PubMed PMID: 19415523.
  19. Cuevas E, ZaldíVar D, PéRez-Cisneros M, Oliva D. Block-matching algorithm based on differential evolution for motion estimation. Engineering Applications of Artificial Intelligence. 2013;26:488-98.
  20. Sun F-R, Wang X-J, Wu Q, Yao G-H, Zhang Y. Measurement of left ventricular torsion using block-matching-based speckle tracking for two-dimensional echocardiography. Journal of Electronic Imaging. 2013;22:013010.
  21. Mobasheri M, Mokhtari-Dizaji M, Roshanali F. Estimating the Myocardium’s Angle of Three-Dimensional Trajectory, Using the Tracking of Sequential Two-Dimensional Echocardiography Images. J Cardiovasc Ultrasound. 2014;22:14-22. PubMed PMID: 24753804. PubMed PMCID: 3992343.
  22. Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zaca V, et al. Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med. 2011;30:71-83. PubMed PMID: 21193707.
  23. Philip JT, Samuvel B, Pradeesh K, Nimmi N, editors. A comparative study of block matching and optical flow motion estimation algorithms. Emerging Research Areas: Magnetics, Machines and Drives (AICERA/iCMMD). 24-26 July 2014. Kottayam: Annual International Conference on; 2014. doi: 10.1109/aicera.2014.6908204.
  24. Liangbao J, Jiao C, Rui C, Xuehong C, editors. A hierarchical block matching algorithm in depth extraction for binocular vision. 21-23 February 2011. Seoul: Proceedings of the 5th International Conference on Ubiquitous Information Management and Communication; 2011. doi: 10.1145/1968613.1968760.
  25. Lumens J, Delhaas T, Arts T, Cowan BR, Young AA. Impaired subendocardial contractile myofiber function in asymptomatic aged humans, as detected using MRI. Am J Physiol Heart Circ Physiol. 2006;291:H1573-9. PubMed PMID: 16679404.
  26. Takeuchi M, Otsuji Y, Lang RM. Evaluation of left ventricular function using left ventricular twist and torsion parameters. Curr Cardiol Rep. 2009;11:225-30. PubMed PMID: 19379643.
  27. Reyhan M, Wang Z, Li M, Kim HJ, Gupta H, Lloyd SG, et al. Left ventricular twist and shear in patients with primary mitral regurgitation. J Magn Reson Imaging. 2015;42:400-6. PubMed PMID: 25408263.
  28. Kendoul F, Fantoni I, Nonami K. Optic flow-based vision system for autonomous 3D localization and control of small aerial vehicles. Robotics and Autonomous Systems. 2009;57:591-602.
  29. Schiros CG, Desai RV, Venkatesh BA, Gaddam KK, Agarwal S, Lloyd SG, et al. Left ventricular torsion shear angle volume analysis in patients with hypertension: a global approach for LV diastolic function. J Cardiovasc Magn Reson. 2014;16:70. PubMed PMID: 25316384. PubMed PMCID: 4177166.
  30. Axel L, Dougherty L. MR imaging of motion with spatial modulation of magnetization. Radiology. 1989;171:841-5. PubMed PMID: 2717762.
  31. Biering-Sorensen T, Jensen JS, Pedersen S, Galatius S, Hoffmann S, Jensen MT, et al. Doppler tissue imaging is an independent predictor of outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Am Soc Echocardiogr. 2014;27:258-67. PubMed PMID: 24325959.
  32. Dragos AM, Abate E, Pinamonti B. Advanced Echocardiographic Techniques in Arrhythmogenic Right Ventricular Cardiomyopathy. Clinical Echocardiography and Other Imaging Techniques in Cardiomyopathies: Springer; 2014. p. 159-64.
  33. Notomi Y, Lysyansky P, Setser RM, Shiota T, Popovic ZB, Martin-Miklovic MG, et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardiol. 2005;45:2034-41. PubMed PMID: 15963406.
  34. Opdahl A, Helle-Valle T, Skulstad H, Smiseth OA. Strain, strain rate, torsion, and twist: echocardiographic evaluation. Curr Cardiol Rep. 2015;17:568. PubMed PMID: 25676830.
  35. Natori S, Lai S, Finn JP, Gomes AS, Hundley WG, Jerosch-Herold M, et al. Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity. AJR Am J Roentgenol. 2006;186:S357-65. PubMed PMID: 16714609.
  36. Williams A, Shave RE, Stembridge M, Eves N, editors. Females have greater left ventricular twist mechanics than males during acute reductions to preload. Am J Physiol Heart Circ Physiol. 2016;311:H76-H84.
  37. Chung AK, Das SR, Leonard D, Peshock RM, Kazi F, Abdullah SM, et al. Women have higher left ventricular ejection fractions than men independent of differences in left ventricular volume: the Dallas Heart Study. Circulation. 2006;113:1597-604. PubMed PMID: 16567580.
  38. Adhyapak SM, Parachuri VR. Architecture of the left ventricle: insights for optimal surgical ventricular restoration. Heart Fail Rev. 2010;15:73-83. PubMed PMID: 19757029.
  39. Hassaballah A, Hassan M, Mardi A, Hamdi M. Modeling the effects of myocardial fiber architecture and material properties on the left ventricle mechanics during rapid filling phase. Appl. Math. 2015;9:161-7.
  40. Von Deuster C, Stoeck CT, Genet M, Atkinson D, Kozerke S. A reference dataset of in-vivo human left-ventricular fiber architecture in systole and diastole. Journal of Cardiovascular Magnetic Resonance. 2015;17:Q112.