OBJECTIVE: The purpose of our study was to analyze left ventricular (LV) torsional deformation in patients with dilated cardiomyopathy (DCMP) using a newly developed two-dimensional (2D) strain analysis. METHODS: We acquired 2D data at three levels of LV parasternal short axis images; mitral valve (MV), papillary muscle (PM) and apical levels (AP); in 8 DCMP patients and 14 controls. These data were analyzed for rotation (R) and rotational rate (RR) using the new 2D speckle tracking based method. Conventional systolic and diastolic functional analysis was performed concomitantly. RESULTS: All patients had significant ventricular dilatation and remodeling. With DCMP, maximum systolic torsion and early diastolic recoil was decreased significantly relative to controls. In controls and DCMP, R at MV; -3.89짹2.21 vs -1.82짹1.11 degrees (deg), R at PM; -3.54짹2.95 vs -0.97짹1.33 deg, R at AP; 5.95짹4.4 vs -1.14짹4.49 deg, maximal systolic RR (SRR) at MV; -36.10짹12.16 vs -15.96짹6.23 deg/second (deg/s), SRR at PM; -30.84짹11.2 vs -4.66짹9.97 deg/s, SRR at AP; 45.56짹19.86 vs 3.78짹21.71 deg/s, early diastolic RR (ERR) at MV; 34.23짹17.10 vs 13.54짹6.43 deg/s, ERR at PM; 20.16짹11.81 vs 8.22짹7.52 deg/s, ERR at AP; -52.13짹19.74 vs -12.98짹22.4 deg/s respectively. CONCLUSIONS: Decreased systolic torsional deformation and loss of early diastolic recoil may contribute to LV dysfunction in DCMP. Analysis of left ventricular torsion with 2D strain can elucidate the role of torsion in patients with DCMP.