Ventricular Torsion: Research Tool or Novel Clinical Indicator?

Concept of ventricular torsion has long history and valuable concepts were established for ventricular torsion contributing to left ventricular (LV) diastolic relaxation and early diastolic filling to generate rapid " suction " power during diastole. However, ventricular torsion had been recognized as only interesting research tools for clinicians because of hard to assess the ventricular torsion in vivo; only available method was tagging magnetic resonance image for a while. Recently interests for ventricular torsion increased after two dimensional (2D) speckle tracking methods has been introduced. Velocity vector imaging is also an equipped image analysis technique and provides strain, strain rate and LV tor-sion. Basal and apical rotation curve is derived by simple off-line analysis and ventricular torsion is automatically calculated by equipped software. Non-invasive, bedside approach using transthoracic echocardiography can provide better information for change of ventricular torsion according to patient's clinical situation. Easier assessment attributed to increase number of researches and clinical trials to apply the ventricular torsion to clinical field to improve the understanding for myocardial mechanics. Further approaches to LV torsion were made as a clinical indicator for decision making and prognostic indicator. Various studies about ventricular torsion in recent studies have suggested clinical implication. 2) To measure LV function accurately, many noninvasive echo-cardiographic parameters have been developed. LV ejection fraction (LVEF) is a good parameter for ventricular function and even though it has numerous limitations, still it is the best clinical indicator to evaluate the ventricular function in most of clinics. Doppler and tissue Doppler follows to LVEF and then, strain is now suggested as a better marker to evaluate the ventricular function but still stands between clinician and researchers. To be used as a clinical indicator, predominant accuracy beyond other functional markers as well as easy approach and reproducibility for measurement. In observational cohort study, to prove higher accuracy of ventricular torsion can be hard to be achieved; however can be suggested with multivariate statistical analysis or subgroup analysis. Ventricular torsion is as far as it goes with other ventricular functional parameters, especially ejection fraction, 3) harder to discriminate its superiority as a clinical indicator especially in patients group with dramatic change of LVEF during observational periods. This study by Deng et al. 4) investigated about the change of ventricular torsion before and after kidney transplantation. Ven-tricular torsion was improved but also global ventricular function including LVEF was improved. Poor ventricular function in patients with …