• New 2025 ASE diastology guidelines recommends a universal algorithm. • This study aimed to assess the prognostic value of 2025 guidelines in patients with MI. • 808 consecutive patients with a first-ever MI were included. • Diastolic dysfunction (DD) was defined as grade 2 or 3 DD. • DD assessed by the 2025 ASE guidelines was a robust independent predictor of survival. New 2025 ASE diastology guidelines recommends a universal algorithm. This study aimed to assess the prognostic value of 2025 guidelines in patients with MI. 808 consecutive patients with a first-ever MI were included. Diastolic dysfunction (DD) was defined as grade 2 or 3 DD. DD assessed by the 2025 ASE guidelines was a robust independent predictor of survival. The 2025 American Society of Echocardiography (ASE) guidelines for the assessment of diastolic dysfunction (DD) recommends a universal algorithm for all patients undergoing echocardiography. This study aimed to evaluate the prognostic value of significant DD (grades 2 + 3) assessed with the 2025 guidelines (DD2025) compared to the 2016 guidelines (DD2016) for predicting all-cause mortality, including the subgroup with LVEF≥40%, following a first-ever myocardial infarction (MI). Retrospective data on 808 consecutive patients with a first-ever MI between 2013 and 2021 were included. Doppler echocardiography was performed within 24 h of admission. Left atrial reservoir strain was measured retrospectively on stored DICOM images in patients who were indeterminate based on other parameters. At a median follow up of 4.5 years, there were 105 deaths (13.0%). DD2025 was present in 190 patients (23.5%) and DD2016 in 125 patients (15.5%), with a moderate concordance between guidelines (Cohen's Kappa 0.55, p < 0.001). On Kaplan-Meier analysis, DD2025 showed a better association with mortality (log-rank χ 2 48.6 versus 23.4 both p < 0.001). On Cox proportional hazards multivariable analysis incorporating significant clinical predictors and LVEF, both DD2025 (HR 1.93, 95%CI 1.23–2.96, p = 0.003) and DD2016 (HR 1.87, 95%CI 1.21–2.89, p = 0.005) were independent predictors of mortality and incremental to LVEF. Inter-model comparisons of model χ 2 , Somer's D and Harrell's C-statistics favored DD2025. In the subgroup with LVEF≥40%, DD2025 remained a powerful independent predictor of mortality (HR 1.93, 95%CI1.23–3.02, p = 0.004). Significant DD assessed by the 2025 ASE guidelines is a robust independent predictor of survival following MI, including the subgroup with LVEF≥40%, and compares favourably with the 2016 guidelines.
Tan et al. (Sun,) studied this question.