Are obesity and left ventricular dysfunction entwined?

This editorial refers to ‘Evaluation of left ventricular rotation in obese subjects by velocity vector imaging’ by Y. Deng et al. , on page 424 in this issue. Our understanding of left ventricular (LV) function and its description using echocardiographic techniques continues to evolve. From measurement of systolic function by ejection fraction, Tissue Doppler parameters are now used to evaluate systolic and diastolic function in the short- and long axis. However, it is now recognized that LV function also involves twisting or torsion. LV torsion results from differences in contraction of the subepicardial and subendocardial fibres. Although its overall importance is still uncertain, Borg and Ray have proposed a unifying framework for progressive heart failure where LV torsion increases in early diastolic dysfunction but reduces in advanced diastolic and progresses in …