〔Abstract〕 Objective To investigate the relationship between echocardiographic parameters of heart failure with preserved left ventricular ejection fraction (HFpEF) and heart failure with reduced left ventricular ejection fraction (HFrEF) with traditional Chinese medicine (TCM) syndrome differentiation of heart failure (HF). Methods A total of 115 HF patients admitted to the outpatient and inpatient departments of cardiovascular Department in University Town Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2019 to December 2021 were collected. Patients were divided into HFpEF group with 55 cases and HFrEF group with 60 cases according to normal or ≥ 45 % left ventricular ejection fraction (LVEF). According to TCM syndrome differentiation of HF, it can be divided into heart-kidney Yang deficiency syndrome, Qi deficiency and blood stasis syndrome, Yang deficiency and water flooding syndrome. Using echocardiography color doppler ultrasonic diagnostic instrument measurement in patients with left ventricular longitudinal strain (LVGLS), left ventricular end-diastolic volume index (LVEDVI), left ventricular contraction at the end of the volume index (LVESVI) and tissue doppler mitral valve early diastolic velocity (e') and early diastolic mitral valve orifice blood flow velocity and mitral annulus velocity ratio (E/e'), to observe the relationship between different syndrome differentiation types and echocardiographic parameters. Results In all HF patients, the LVEDVI and E/e' of heartkidney Yang deficiency syndrome, Qi deficiency blood stasis syndrome and Yang-deficiency water-flooding syndrome increased and E' decreased successively. In HFpEF patients, LVGLS of heart and kidney Yang deficiency syndrome, Qi deficiency and blood stasis syndrome, Yang deficiency and water syndrome decreased successively. In HFrEF patients, the LVEDVI, LVESVI and E/e' of heartkidney Yang deficiency syndrome, Qi deficiency blood stasis syndrome and Yang deficiency water flooding syndrome were increased and E' was decreased successively, with statistical significance (P < 0.05). LVGLS in HFpEF group was significantly higher than that in HFrEF group, the difference was statistically significant (P < 0.05). LVGLS and E' in HFpEF group were significantly higher than those in the HFrEF group, LVEDVI and LVESVI were significantly lower than those in the HFrEF group, with statistical significances (P < 0.05). LVGLS of HFpEF group was significantly higher than that in the HFrEF group, LVEDVI and LVESVI were significantly lower than those in the HFrEF group, the differences were statistically significant (P < 0.05). Conclusion TCM syndrome differentiation and classification of HFpEF and HFrEF have certain difference and regularity with different parameters of echocardiography, and there is a quantitative relationship between them. Echocardiographic parameters can reflect the disease progression of HF, which has guiding significance for dialectical classification of HF in TCM.