To assess the normal value of left ventricular twist (LVtw) and examine the changes with normal aging by 2-dimensional ultrasound speckle-tracking imaging (STI), 121 healthy volunteers were divided into three age groups: a youth group (19–45 y old), a middle-age group (46–64 y old ) and an old-age group (≥65 y old). Basal and apical short-axis images of left ventricular were ac- quired to analyse LV rotation (LVrot) and LVrot velocity. LVtw and LVtw velocity was defined as apical LVrot and LVrot velocity relative to the base. Peak twist (Ptw), twist at aortic valve closure (AVCtw), twist at mitral valve opening (MVOtw), untwisting rate (UntwR), half time of untwisting (HTU), peak twist velocity (PTV), time to peak twist velocity (TPTV), peak untwisting velocity (PUV), time to peak untwisting velocity (TPUV) were separately measured. The results showed that the normal LV performs a wringing motion with a clockwise rotation at the base and a counterclock- wise rotation at the apex (as seen from the apex). The LVtw velocity showed a systolic counterclock- wise twist followed by a diastolic clockwise twist. Peak twist develops near the end of systole (96%±4.2% of systole). With aging, Ptw, AVCtw, MVOtw, HTU and PUV increased significantly (P<0.05) and UntwR decreased significantly (P<0.05). However, no significant differences in TPUV, PTV and TPTV were noted among the 3 groups (P>0.05). It is concluded that LV twist can be meas- ured non-invasively by 2-dimensional ultrasound STI imaging. The age-related changes of LVtw should be fully taken into consideration in the assessment of LV function. To assess the normal value of left ventricular twist (LVtw) and examine the changes with normal aging by 2-dimensional ultrasound speckle-tracking imaging (STI), 121 healthy volunteers were divided into three age groups: a youth group (19-45 y old, a middle-age group (46-64 y old) and an old-age group (≥65 y old). Basal and apical short-axis images of left ventricular were ac- quired to analyze LV rotation (LVrot) and LVrot velocity. LVtw and LVtw velocity were defined as apical LVrot and LVrot velocity relative to the base. Peak twist (Ptw), twist at aortic valve closure (AVCtw), twist at mitral valve opening (MVOtw), untwisting rate (UntwR) time to peak twist velocity (TPUV), peak untwisting velocity (PUV), time to peak untwisting velocity (TPUV) were separately measured. The results showed that the normal LV performs a wringing motion with a clockwise rotation at the base and a counterclock- wise rotation at the apex The LVtw velocity showed a systolic counterclockwise-wise twist followed by a diastolic clockwise twist. Peak twist develops near the end of systole (96% ± 4.2% of systole). With aging, Ptw, AVCtw, It is concluded that LV (P <0.05) and UntwR decreased significantly (P <0.05). However, no significant differences in TPUV, PTV and TPTV were observed among the 3 groups twist can be meas- ured non-invasively by 2-dimensional ultrasound STI imaging. The age-related changes of LVtw should be fully taken into consideration in the assessment of LV function.