Background: Newly developed 2-dimensional speckle tracking imaging provides simultaneous information on cardiac rotation with different rotational rate throughout the cardiac cycle, thus, providing the opportunity to noninvasively construct twist loops. The aim of this study was to examine the effect of level (base to apex) on cardiac twist. Methods: From base to apex, 2D left ventricular (LV) short-axis images with high frame rates were acquired in 20 asymptomatic patients. Using EchoPAC��� workstation, LV rotation and rotational rate were obtained at each plane by 2D speckle tracking analysis. LV twist was defined as apical LV rotation relative to the base. Results: During systole, a substantial degree and rotational rate of twisting developed at cardiac base and mid, despite a relatively small at apex. A much steeper rotation and rotational rate relationship observed at base rather than at apex (Figure). Conclusion: Systolic twist increased at base and mid portion rather than at apex. The increase in twist observed may play an important role in facilitating LV contraction.