Intensive Care Medicine

, Volume 37, Issue 1, pp 156–163 | Cite as

Left ventricular rotation: a neglected aspect of the cardiac cycle

  • Stefan BloechlingerEmail author
  • Wilhelm Grander
  • Juerg Bryner
  • Martin W. Dünser
Physiological and Technical Notes



To describe the mechanics and possible clinical importance of left ventricular (LV) rotation, exemplify techniques to quantify LV rotation and illustrate the temporal relationship of cardiac pressures, electrocardiogram and LV rotation.

Materials and methods

Review of the literature combined with selected examples of echocardiographic measurements.


Rotation of the left ventricle around its longitudinal axis is an important but thus far neglected aspect of the cardiac cycle. LV rotation during systole maximizes intracavitary pressures, increases stroke volume, and minimizes myocardial oxygen demand. Shearing and restoring forces accumulated during systolic twisting are released during early diastole and result in diastolic LV untwisting or recoil promoting early LV filling. LV twist and untwist are disturbed in a number of cardiac diseases and can be influenced by several therapeutic interventions by altering preload, afterload, contractility, heart rate, and/or sympathetic tone.


The concept of LV twisting and untwisting closely linking LV systolic and diastolic function may carry potential diagnostic and therapeutic importance for the management of critically ill patients. Future clinical studies need to address the feasibility of assessing LV twist and untwist as well as the relevance of its therapeutic modulation in critically ill patients.


Left ventricular twist Untwist Torsion Recoil Systolic function Diastolic function Critically ill patients 


Conflict of interest

No author has a conflict of interest in regards of methods, techniques, or drugs discussed in this manuscript.

Supplementary material

134_2010_2053_MOESM1_ESM.avi (2 mb)
Video 1. Torsion is shown as a function of circumferential strain in a color-coded three-dimensional image of the left ventricle. Torsion is calculated as the difference in rotation between the apex and the base. Note the opposite rotation of the base and apex coded as brown-beige-yellow at the base and blue-turquoise at the apex, respectively. Note that for technical reasons three-dimensional echocardiography currently allows for a maximum frame rate of 19.1 frames per second only (AVI 2040 kb)
134_2010_2053_MOESM2_ESM.avi (2.1 mb)
Video 2. Three-dimensional speckle tracking demonstrating radial strain of the subepicardial and subendocardial layers: the inferior segment shows the largest counterclockwise torsion (viewed from the base). Note that for technical reasons, three-dimensional echocardiography currently allows for a maximum frame rate of 19.1 frames per second only (AVI 2158 kb)


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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Stefan Bloechlinger
    • 1
    Email author
  • Wilhelm Grander
    • 2
  • Juerg Bryner
    • 3
  • Martin W. Dünser
    • 1
  1. 1.Department of Intensive Care MedicineUniversity Hospital Bern, InselspitalBernSwitzerland
  2. 2.Department of Internal MedicineCommunity Hospital Hall in TirolHall in TirolAustria
  3. 3.ZurichSwitzerland

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