Heart failure & cardiomyopathies
Echocardiographic Diastolic Function Grading in Heart Failure with Preserved Ejection Fraction (HFpEF): Testing the Updated 2025 American Society of Echocardiography (ASE) Criteria
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 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
Methodological detailsprospective cohort, external validation cohort
- Prospective cohort
- External validation cohort
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: Testing the Updated 2025 ASE Criteria. J Am Coll Cardiol. Published 14 January 2026. doi:10.
Summarised from the published abstract; every number is checked against it