New options in noninvasive assessment of left ventricular torsion

The complex, intricate 3D pattern of ventricular torsion has both fascinated and perplexed scientists for centuries. The identity of the underlying anatomic myocardial unit responsible for this pattern of contraction continues to be an arena of debate. While the complicated wringing motions involved in torsion are difficult to quantify, several techniques have been demonstrated to be effective in the noninvasive assessment of left ventricular (LV) torsion. Magnetic resonance tissue-tagging with dynamic MRI is the gold standard for the noninvasive quantitative evaluation of torsion with high spatial and temporal resolution. However, this is a technically involved and potentially time-consuming process. Echocardiography is another alternative noninvasive method. Both tissue Doppler imaging and speckle-tracking imaging have been shown to be sufficiently accurate and reliable alternatives to MRI in the noninvasive assessment of LV torsion. While the potential applications of these techniques to assess LV torsion appears boundless, further studies are needed to validate measures of LV torsion by the additional, but most important, test of demonstrating its clinical utility as a predictor of prognosis.