Purpose: Left ventricular torsion is known to be decreased in severe pulmonary hypertension. Apical rotation is affected by LV preload and geometry. We evaluated LV torsion in mild-to-moderate pulmonary hypertension with normal LV EF and geometry. Methods: Thirteen mild-to-moderate pulmonary hypertension(PAH) patients and age-matched control subjects(CON) underwent echocardiogram. Echocardiograms were digitally stored and analysed offline. LV torsion was calculated as the maximal difference between the apical and basal rotation curves during systole. Mural torsion was calculation as the difference between the subendocardial and epicardial rotation. Results: Peak pulmonary artery pressure was 34.4짹4.1mmHg in PAH group. LV ejection fraction was not different in two groups (63.5짹8.2 vs. 67.0짹3.7, p=0.18). LV torsion was decreased in PAH group than CON (6.4짹2.5 vs. 8.3짹1.9, p=0.04). Basal rotation was preserved (-2.8짹1.8 vs. -3.1짹1.4, p=0.65) but apical rotation was significantly decreased (3.5짹1.6 vs. 5.2짹1.9, p=0.03) in PAH. Basal and apical mural torsions were not different in two groups. Conclusion: In mild-to-moderated pulmonary hypertension, LV torsion was decreased. Decreased apical rotation is contributing to decreased LV torsion even in normal LV geometry.