How can echocardiography differentiate between systolic and diastolic dysfunction?

Echocardiography differentiates between systolic and diastolic dysfunction primarily through the evaluation of the E/A ratio on Doppler mitral inflow. This assessment involves measuring the early (E) and late (A) diastolic velocities of blood flow across the mitral valve.

In a healthy heart, the E wave is typically larger than the A wave, indicating that the majority of the filling occurs rapidly during early diastole when the ventricles are relaxed. In cases of diastolic dysfunction, this E/A ratio is altered. For instance, if there is impaired relaxation of the left ventricle, the E wave may decrease while the A wave increases, leading to a reduced E/A ratio, which is a hallmark of diastolic dysfunction.

Systolic dysfunction is characterized by a reduced left ventricular ejection fraction, which can be measured but does not specifically distinguish it from diastolic dysfunction. While wall motion abnormalities can indicate systolic issues, they do not provide direct insight into diastolic function. Comparing right and left ventricular sizes can help determine overall cardiac function and heart failure type, but this approach is not specific enough to differentiate between systolic and diastolic dysfunction. Thus, evaluating the E/A