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Background This study aimed to evaluate the twist/untwist parameters of the left ventricle (LV) in patients with heart failure with preserved ejection fraction (HFpEF) measured by ultrasonic two‐dimensional speckle tracking echocardiography (STE) and to examine the correlations between twist parameters and serum N‐terminal pro b‐type natriuretic peptide (NT‐proBNP) as well as conventional two‐dimensional echocardiography (2DE) indexes. Hypothesis Changes in twist/untwist parameters can be used to evaluate LV function in HFpEF patients. Methods In 63 HFpEF patients and 40 healthy controls, we analyzed LV twist/untwist parameters by STE, cardiac function by 2DE, and serum NT‐proBNP by enzyme‐linked immunosorbent assay (ELISA). The correlations between twist/untwist parameters and 2DE parameters and serum NT‐proBNP were examined by Pearson correlation analysis. Results Left ventricular end diastolic inner diameter and ejection fraction in HFpEF patients were within the normal range, whereas other 2DE parameters including left ventricular posterior wall end diastolic thickness, interventricular septal thickness, left atrial volume index, E, E/A, and E/e' differed significantly between HFpEF patients and control subjects. The twist/untwist parameters such as peak apical rotation (Par), peak untwisting velocity (PUWV), and isovolumic diastole untwisting percentage (Iutw%) were significantly decreased in HFpEF patients compared with control participants. Positive correlations between PUWV/Iutw% and E/A/E/e' and a significant negative correlation between PUWV/Iutw% and left atrial volume index (LAVI) were observed. The plasma NT‐proBNP concentration was positively correlated with LAVI, but negatively correlated with PUWV and Iutw%. Conclusions Changes in twist/untwist parameters correlate well with conventional 2DE parameters and plasma levels of NT‐proBNP, and can be used to evaluate LV function in HFpEF patients. Par is sensitive to the LV myocardial function damage.

Nearly one century has passed since Thomas Cullen, in his book Cancer of the Uterus published in 1900, described the treatment of endometrial carcinoma with abdominal hysterectomy and bilateral salpingo-oophorectomy and recommended vaginal hysterectomy only in the very obese or medically indigent patients. In the 1920s, Healy was one of the first to study the effects of radiation alone and in combination with surgery in the treatment of endometrial carcinoma. It confirmed that poorly differentiated carcinoma was more difficult to be treated successfully. In 1936, Arneson compared radiation plus surgery with surgery and radiation alone and found that the combination of radiation, followed 3–6 weeks later by hysterectomy was the best method to treat cancer of the corpus uteri and yielded improved 5-year survival. In 1941 Heyman developed a technique of packing the uterus with multiple capsules of radium prior to hysterectomy and showed approximately 60% 5-year survivals in stage I patients.

Endometrial carcinoma is primarily a disease of postmenopausal women. The peak incidence between 55 and 59 years of age is later than for cervical cancer. Only 2%–5% of all cases are diagnosed before the age of 40 and there is a sharp drop in the incidence after 70 years of age. Only 20%–25% of cases occur in premenopausal women (Silverberg 1975; Mattingly 1985; Aalders et al. 1980; Malkasian et al. 1980).

Endometrial carcinoma is also called corpus cancer. During the past 20 years there has been a drastic increase in the worldwide incidence of endometrial carcinoma, such that in many areas endometrial carcinoma is now ranked as the second or third most common malignant neoplasm of the female genital tract. The reported incidence varies according to country, area, and race. According to the International Agency for Research on Cancer (1982), incidence rates are especially high in North America and northern Europe and are low in Central America and Asia (Fig. 1.1). The American Cancer Society reported that approximately 37000 women would develop endometrial carcinoma in 1979. Therefore, this lesion is seen over twice as frequently as carcinoma of the ovary and cervix (Cancer Statistics 1979). Masubuchi et al. (1975) reported 1958 patients with endometrial carcinoma and 38080 patients with cervical cancer during the 12 years from 1961 to 1972, based on records collected from 33 university hospitals and cancer centers in Japan, giving a ratio of the incidence of endometrial carcinoma to cervical cancer of 1:19.5. In the United States, the ratio of the incidence of endometrial carcinoma to cervical cancer was reported to be 1:2 during the period 1969–1970 (Duun 1974).

In the FIGO Annual Report (1985), 5-year survival was 67.7% in 13 581 cases of endo-metrial carcinoma (Table 5.1). The reported figures of survival have been consistent, ranging from 66% to 77% (Frick et al. 1973; Morrow et al. 1973; Berman et al. 1980; Connelly et al. 1982; Kauppila et al. 1982). Li (1988), reviewing 418 cases of endometrial carcinoma, found 5-year survival to be 77.6% for stage I, 59.6% for stage II, and 61.9% for stages I–IV respectively. The low mortality is probably related to the fact that over 80% of the cases were confined to the uterus (FIGO stages I, II) at initial diagnosis and approximately 75% of cases could be treated by surgery and/or radiotherapy.