Both global and regional systolic function are to be checked. Global measures include ejection fraction, stroke volume, end systolic volume. (For measurement of systolic function using M-mode and 2D echocardiography refer to the section on Echocardiography.) In diastolic dysfunction there is generally presence of left ventricular hypertrophy. The transmitral flow is studied by pulsed Doppler. In normals the early filling velocity (E-wave) is larger than the velocity during atrial contraction (A-wave) and the descent is fast. In diastolic dysfunction there are in general 2 types of patterns. When relaxation is impaired the E-wave becomes smaller and its deceleration time is prolonged and the A-wave becomes taller. With restrictive physiology the E-wave becomes taller and the deceleration time is shorter and the A-wave is smaller. There are also abnormalities in the pulmonary venous flow patterns.