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A hallmark of restrictive cardiomyopathy on imaging is diastolic dysfunction with preserved ejection fraction. In this condition, the heart muscle becomes rigid and less compliant, leading to impaired filling of the ventricles during diastole. As a result, patients exhibit symptoms of heart failure, particularly during exertion, due to inadequate filling of the ventricles despite having preserved contractile function.

In restrictive cardiomyopathy, the ejection fraction, which measures the heart's ability to pump blood, often remains normal (or nearly normal). This preservation of ejection fraction can sometimes lead to a misconception about the severity of the condition because patients may not exhibit effective symptoms of systolic heart failure, which is commonly seen in other types of cardiomyopathy.

Overall, identifying diastolic dysfunction with a preserved ejection fraction is crucial for recognizing restrictive cardiomyopathy on imaging studies, differentiating it from other types of heart failure where systolic dysfunction is prevalent.