The left ventricle twists in systole storing potential energy and untwists (recoils) in diastole releasing the energy. Twist aids left ventricular ejection and untwist aids relaxation and ventricular filling. Therefore, rotation and torsion are important in cardiac mechanics. However, the methodology of their investigations is limited to invasive techniques or magnetic resonance imaging. With the advent of speckle tracking echocardiography, however, rotation and torsion (twist) become familiar to echocardiographers. In this review, I outline the mechanism and influencing factors of rotation and torsion with the anticipation of the routine use of these measurements in clinical practice.