doi:10.1016/j.ultrasmedbio.2008.03.022 ● Original Contribution A NEW TISSUE DOPPLER METHOD FOR EXAMINATION OF LEFT VENTRICULAR ROTATION JONAS CROSBY,* BRAGE H. AMUNDSEN,* THOMAS HELLE-VALLE, † PER ARVID STEEN, ‡ and HANS TORP* *Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim; † Institute for Surgical Research, Department of Cardiology, Rikshospitalet University Hospital, Oslo; and ‡ St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway (Received 2 October 2007; revised 7 March 2008; in final form 24 March 2008) Abstract—This paper introduces a new semiautomatic method for assessing regional left ventricular (LV) rotation that uses the velocity field provided by tissue Doppler imaging (TDI). Left ventricular end-systolic angle of twist estimated by the new method has been compared with rotation by magnetic resonance imaging (MRI) tagging, by 2-D speckle tracking echocardiography (STE) and by a TDI method using the velocity difference between the tangential points on the LV circumference in 21 human subjects. The new TDI method gave lower absolute values for end-systolic twist angle than MRI and STE (agreement 4.1  2.1° and 2.5  4.0°, respectively). The reproducibility of the new method was as good as for MRI and STE, but worse than the use of TDI velocities in tangential points. The present study has shown that TDI methods constitute useful alternatives to speckle tracking and MRI, and should be considered in future studies of LV twist and rotation. (E-mail: jonas.crosby@ntnu.no) © 2008 World Federation for Ultrasound in Medicine & Biology. Key Words: Echocardiography, Left ventricular function, Magnetic resonance imaging, Left ventricular torsion, Left ventricular rotation, Tissue Doppler imaging. INTRODUCTION During the cardiac cycle, the left ventricular (LV) myo- cardium rotates around its long axis. The rotation varies along the long axis, resulting in an angle of twist of the apex relative to the base. The pattern of rotation is observed to be stable over time in healthy subjects, but is sensitive to changes in both regional and global LV function (Hansen et al. 1991; Maier et al. 1992; Kroeker et al. 1995; Tibayan et al. 2004; Helle-Valle et al. 2005; Takeuchi et al. 2007). Therefore, assessment of LV ro- tation has been suggested as an approach for quantifying LV function. Magnetic resonance imaging (MRI) tag- ging has predominantly been the method to examine LV rotation and twist. Speckle tracking echocardiography (STE) on short axis (SAX) views has recently been introduced as an ultrasound-based method for assessing LV rotation (Notomi et al. 2005a; Helle-Valle et al. 2005). Garot et al. (2002) suggested a method based on tissue Doppler imaging (TDI), where the rotation was found from the circumferential displacement of a region of the LV wall where the observed Doppler shift was zero. However, the physical foundation of this method- ology has been questioned (D’hooge et al. 2002). A later paper by Notomi et al. (2005b) presented a different TDI method in which the rotation was estimated using the velocities from the points of tangency between the LV wall and the ultrasound beams. This paper presents a new complementary method for estimation of regional and global rotation from the velocity field provided by tissue TDI. The method is related to the method suggested by Notomi et al. (2005b), but differs by making use of the velocity infor- mation in all visible parts of the LV wall, thereby allow- ing calculation of regional rotation and circumferential strain. Left ventricular rotation and twist angle measured by the new method (hereinafter referred to as TDI 1 ) are compared with results from the TDI method suggested by Notomi et al. speckle-tracking in B-mode images, and MRI tagging (referred to as the TDI 0 , STE and MRI methods, respectively). We chose to study the methods Video Clips cited in this article can be found online at: http:// www.umbjournal.org. Address correspondence to: Jonas Crosby, Department of Circu- lation and Medical Imaging, MTFS, N-7489 Trondheim, Norway. E-mail: jonas.crosby@ntnu.no Ultrasound in Med. & Biol., Vol. 34, No. 11, pp. 1741–1751, 2008 Copyright © 2008 World Federation for Ultrasound in Medicine & Biology Printed in the USA. All rights reserved 0301-5629/08/$–see front matter 1741