EDITORIAL About left ventricular torsion, sex differences, shear strain, and diastolic heart failure

This editorial refers to ‘Preserved left ventricular twist and circumferential deformation, but depressed longitudi-nal and radial deformation in patients with diastolic heart failure’ † by J. Wang et al., on page 1283 ‘An attempt at visualizing the Fourth Dimension: Take a point, stretch into a line, curl it into a circle, twist it into a sphere, and punch through the sphere’. Albert Einstein Wang et al.1 provide novel pathophysiological information on patients with diastolic heart failure, by exploring the fourth dimen-sion of cardiac function: left ventricular (LV) twist. The complex active and passive physiological events occurring during the heart cycle are related to the complex structure of the heart, which is a helix that contains an apex. Lower (17th century) described the cardiac helix form as having an apical vortex, in which the muscle fibres go from outside in, in a clockwise way, and fro