Echocardiographic Assessment of Left and Right Ventricular Systolic Function Beyond Ejection Fraction

The assessment of left and right ventricular systolic function is vital information for the management of cardiac disease. Everyday clinical practice has traditionally relied on the measurement of the ejection fraction (EF). Nonetheless, EF has known limitations and may not always accurately reflect myocardial systolic performance. Intrinsic myocardial contractility may decline long before reductions in left or right ventricular EF become apparent. Adjunct parameters such as tissue Doppler-derived systolic velocities of the mitral and tricuspid annulus may detect such early abnormalities; however, they do not represent global systolic performance. Consequently, commonly used indices may exhibit suboptimal performance for the detection of systolic dysfunction. Given the limitations of current measurement methods, there is growing concern about the reliability of heart failure (HF) classification based solely on EF. The integration of advanced echocardiographic indices, such as speckle-tracking-derived strain, three-dimensional (3D) volumetric assessment, myocardial work (MW), and cardiac power output (CPO), in combination with classical parameters provides more accurate, reproducible, and clinically meaningful diagnostic and prognostic information in patients with HF. Nevertheless, despite their potential, these techniques remain underutilized in routine practice. Early identification of systolic dysfunction and timely initiation of therapy can substantially improve clinical outcomes. In this setting, this review aims to comprehensively examine both established and emerging echocardiographic techniques used for the assessment of ventricular systolic performance, with the objective of promoting their effective integration into routine clinical practice.