Background: Different patterns of left ventricular (LV) vortex flow are associated with variation in patient���s symptoms and hemodynamics, however the mechanisms of these findings remain undefined. We investigated whether LV vortex flow correlates with LV twist and torsion. Methods: 15 normals and 20 patients with heart failure (13 with SHF and 7 with DHF) underwent 2 dimensional contrast echocardiography(CE) with Definity. LV vorticity was estimated by particle image velocimetry. We measured quantitative LV vortex flow parameters including morphologic and pulsatility indices. We also measured rotation, rotation velocity and torsion using vector velovity imaging (VVI). Results: LV vortex pulsatility parameter (vortex relative strength, VRS) was in the range of 0.387짹0.12 correlated with apical rotation (AR), r=0.751, p=0.008; apical rotation velocity(ARV), r=0.720, p=0.012; apical reverse rotation velocity (ARRV), r=-0.727, p=0.011 and LV torsion, r=0.748, p=0.007. Minimal vortex size (min-VS, 29.8짹11.5) was correlated with ARRV and LV torsion (r=-0.702, p=0.035 and r=0.718, p=0.029, respectively). There was no significant correlation between maximal vortex size and LV mechanic parameters. In multivariate analysis ARRV (OR 1.27, 95% CI 0.98 - 1.47, p<0.05) and LV torsion (OR 1.15, 95% CI 1.00 - 1.33, p<0.05) were independent factor of pulsatility of LV vortex. Furthermore, LV torsion is independent factor of LV vortex size (OR 1.77, 95% CI 1.02 - 3.08, p<0.05). Figure shows Conclusion: LV vortex size and pulsatility correlates with LV twist and torsion and maybe a sensitive indicator of global LV function and intracardiac hemodynamics in patients with HF.