The Doppler echocardiographic examination is the most important and common method used for cardiac imaging due to its safety, its relatively low cost and the great amount of morphofunctional information it can provide. It also plays a relevant role in the assessment of cardiac involvement underlying systemic diseases, in most of which the complication rate is often subclinical and represents one of the main causes of mortality. Advances in technology have lead to an increase in diagnostic accuracy and the range of applications of echocardiography. Among the new techniques, tissue Doppler echocardiography has been shown to identify early ventricular changes in both diastolic and systolic phases and in the preclinical stage of systemic diseases such as amyloidosis, systemic lupus erythematosus, vasculitis, with possible cardiac involvement. The increased sensitivity derives from the possibility of assessing longitudinal mechanics, which seems affected earlier than the circumferential one by pathological processes. Tissue Doppler echocardiography analysis, associated with a complete clinical history, can make an early diagnosis or arise a diagnostic suspicion to the physician, allowing early detection and rapid implementation of diagnostic and therapeutic measures able to improve patient prognosis.