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. Author manuscript; available in PMC: 2007 Aug 24.
Published in final edited form as: J Am Soc Echocardiogr. 2007 May;20(5):539–551. doi: 10.1016/j.echo.2006.10.013

Figure 4.

Figure 4

Left ventricular apex rotation (twist) measured by 2-D speckle tracking of B-mode ultrasound images (2D strain) in a normal individual (A). An initial clockwise rotation occurs during the preejection period, followed by counterclockwise twisting during the ejection phase. Clockwise untwisting occurs predominantly during the phase of isovolumic relaxation. The adjoining panel (B) shows apical twist in a patient with dilated cardiomyopathy with dysfunctional apex. The apical twist sequence is completely the reverse of normal, i.e. apex rotates in clockwise direction during ejection, and in counterclockwise direction in diastole. Phases 1–5 are described in Fig. 3 legend.