Heart failure & cardiomyopathiesDiagnostic or prognostic study
Echocardiographic Diastolic Function Grading in Heart Failure with Preserved Ejection Fraction (HFpEF)
- Diagnostic accuracy study
- prospective cohort
- external validation cohort
Authors' conclusion
Among patients with invasively proven HFpEF, the 2025 ASE algorithm frequently assigns normal or low diastolic grades, and the recommended stress criteria detect only a minority of cases.
Study context
- Population
- HFpEF, ambulatory (invasively confirmed) and hospitalized/decompensated
- Comparison
- 2025 American Society of Echocardiography (ASE) diastolic function algorithm in invasively confirmed HFpEF
- Ambulatory/compensated HFpEFn = 756
- Decompensated HFpEFn = 88
- Outcome
- False-negative rate of the 2025 ASE algorithm in invasively confirmed ambulatory HFpEF; change in diastolic grades from decompensation to recompensation
Performance
As reported in the abstract
Diastolic grade by 2025 ASE algorithm, ambulatory HFpEF
- Normal
- 248 of 756 (32.8%)
- Grade 1
- 263 of 756 (34.8%)
- Grades 2 to 3
- 219 of 756 (30.0%)
- Indeterminate
- 26 of 756 (3.4%)
- Normal or Grade 1 with resting PAWP ≥15 mm Hg
- >60%
- Grade 1 meeting ASE stress criteria
- 11 of 116 (9.5%)
- False-negative rate (Grade 1 with stress imaging)
- 90.5%
- Decompensated: normal or Grade 1
- 22 of 88 (25.0%)
- After recompensation: normal or Grade 1
- 45 of 88 (51.1%)
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause death or HF hospitalization, HFpEF normal or Grade 1 vs controls | 5.37 (1.27–22.6) | |
| 0.050.21520Hazard ratio (log scale) |
Discrimination of HFpEF from noncardiac dyspnea
- AUC
- 0.61
Original publication
Echocardiographic Diastolic Function Grading in HFpEF. J Am Coll Cardiol. Published 14 January 2026. doi:10.1016/j.jacc.2025.11.024
Summarised from the published abstract; every number is checked against it