In their extensive state-of-art report on the echocardiographic evaluation of systolic and diastolic function in patient with cardiac amyloidosis, Liu et al dedicated much space to tissue Doppler imaging, strain rate imagining, and 2-dimensional speckle-tracking imagining but made no mention of a particular behavior of left ventricular (LV) motion defined as twisting and untwisting. It consists of LV torsional deformation around the longitudinal axis, originating from the dynamic interaction between the systolic clockwise rotation of the base and the counterclockwise rotation of the apex, followed by untwisting during diastole. Porciani et al recently published a comprehensively 2-dimensional strain evaluation of patients with amyloid light chain amyloidosis. They demonstrated that LV longitudinal strain was reduced in patients with echocardiographic evidence of cardiac amyloidosis. Moreover, they demonstrated that LV twisting and untwisting motions are increased in patients with amyloid light chain systemic amyloidosis and no evidence of cardiac involvement, while these motions are reduced in patients with evident amyloidosis cardiac involvement. This finding suggests that early in the disease, the impaired LV relaxation induces a compensatory mechanism that fails in more advanced stages of the disease, when twisting and untwisting rates are reduced. Moreover, the investigators demonstrated that the LV untwisting rate peak time was delayed in patients with and those without echocardiographic evidence of cardiac amyloidosis, irrespective of LV mass. Cappelli et al extended these observations, comparing patients with amyloidosis and normal LV mass to those with essential arterial hypertension and normal LV mass. Despite similar values of twisting and untwisting rates, patient with systemic amyloidosis and normal LV mass demonstrated a significant delay of untwisting rate peak time. These data suggest that different causes of cardiac involvement could differently affect LV untwisting rate irrespective of LV mass. Because twisting and untwisting provide a unique vision of systolic and diastolic motion, we thought that its investigation in patients with amyloidosis might provide new insight into the underlying mechanisms of cardiac amyloidosis involvement. Furthermore, because 2-dimensional strain evaluation of LV rotational mechanics is a widely available echocardiographic technique, we think that this noninvasive examination should be known to all clinicians involved in the diagnosis and management of systemic amyloidosis.