Comparison of the 2016 ASE/EACVI and 2025 ASE Guidelines for Assessing Left Atrial Pressure in Patients with Normal Left Ventricular Ejection Fraction

BACKGROUND: The assessment of diastolic dysfunction in patients is clinically challenging. The 2025 ASE guidelines for assessment of left atrial pressure were published recently and their diagnostic performance need further validation. OBJECTIVES: This study aimed to evaluate the diagnostic performance of the 2025 ASE guidelines for assessment of left atrial pressure and to compare it with that of the 2016 ASE/EACVI guidelines. METHODS: This study prospectively collected echocardiographic data and left atrial pressure (LAP) measurements from 119 patients. Patients were categorized into elevated left atrial pressure（ELAP） (LAP >15 mmHg) and normal (LAP ≤15 mmHg) groups. Both the 2016 ASE/EACVI and 2025 ASE guidelines were applied to assess diastolic function using echocardiographic parameters. RESULTS: The 2025 guidelines demonstrated significantly higher sensitivity (86.4% [75.7-93.6] vs. 54.0% [39.3-68.2]) and feasibility (100% [98.0-100] vs. 78.1% [72.2-84.0]) but lower specificity (81.8% [73.8-88.2] vs. 94.8% [88.3-98.3]) and positive predictive value (72.2% [63.7-79.3] vs. 84.4% [68.9-92.9]) compared to the 2016 guidelines. Negative predictive value (91.7% [85.6-95.3] vs. 79.8% [74.5-84.3]) and overall accuracy (83.4% [77.3-88.5] vs. 80.8% [73.5-86.9]) improved modestly. CONCLUSIONS: The 2025 guidelines significantly improved the feasibility of assessing LAP and enhanced ELAP detection rates and applicability while maintaining comparable accuracy.