Key result
The 2025 ASE guidelines diagnose ~22% more LVDD than 2016 criteria, eliminating all indeterminate cases.
Why the study?
Echocardiographic evaluation of left ventricular diastolic dysfunction remains ambiguous in asymptomatic elderly patients with preserved ejection fraction.
Do the 2025 ASE recommendations improve diagnostic consistency and reduce indeterminate classifications of left ventricular diastolic dysfunction compared to the 2016 guidelines in asymptomatic elderly inpatients with preserved LVEF?
Observational (n=2,058)
Yes
Do the 2025 ASE recommendations improve diagnostic consistency and reduce indeterminate classifications of left ventricular diastolic dysfunction compared to the 2016 guidelines in asymptomatic elderly inpatients with preserved LVEF?
Absolute Event Rate: 29.3% vs 24%
The 2025 ASE guidelines for left ventricular diastolic dysfunction eliminate indeterminate classifications and increase detection rates in asymptomatic elderly patients compared to the 2016 guidelines.
2025 ASE guidelines may reclassify LVDD in asymptomatic elderly with preserved LVEF; leaves open optimal diagnostic approach pending prospective validation.
Background Echocardiographic evaluation of left ventricular diastolic dysfunction (LVDD) remains ambiguous in asymptomatic elderly patients with preserved left ventricular ejection fraction (LVEF). This study aimed to assess the impact of the 2025 updated ASE guidelines on the diagnosis of LVDD in asymptomatic elderly inpatients with preserved ejection fraction, and to compare the diagnostic consistency of diastolic function grading between the 2016 and 2025 ASE guidelines. Methods A multi‐center retrospective study was conducted. A total of 2058 elderly patients who underwent hospitalization and surgery between January 2025 and December 2025 were enrolled. Patients with LVEF <50% or cardiac symptoms were excluded. All subjects received a comprehensive transthoracic echocardiography. Left ventricular diastolic function was graded in accordance with the 2025 and 2016 ASE recommendations, respectively. The Kappa coefficient and overall agreement rate were calculated to analyze inter‐guideline consistency. Results Mean age was 70.8 ± 7.98 years, and 48.64% of patients were female. The prevalence of LVDD diagnosed according to the 2025 recommendations was higher than that diagnosed according to the 2016 guidelines (29.3% vs. 24%). Statistically significant inter‐group differences were observed in core echocardiographic parameters across all diastolic function strata, including E/A ratio, e’ peak velocity, average E/e’ ratio, left atrial volume index (LAVi), and Tricuspid regurgitation peak velocity(TR) ( p < 0.001). Using the 2016 criteria, 12.8% of patients were classified as indeterminate diastolic function. The 2025 ASE algorithm eliminated all indeterminate cases, reclassifying them as normal diastolic function ( n = 80), grade 1 diastolic dysfunction ( n = 108), and grade 2 diastolic dysfunction ( n = 76). Moderate diagnostic consistency was identified between the two guidelines (Kappa = 0.441), with an overall agreement rate of 75.3%. Conclusions Compared with the 2016 ASE guidelines, the 2025 updated ASE recommendations optimize the evaluation framework for left ventricular diastolic function in elderly patients, markedly reduce diagnostic indeterminacy, improve detection rates of LVDD, and demonstrate superior clinical applicability and risk stratification value.
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Chen et al. (2026) conducted an observational in Left ventricular diastolic dysfunction (n=2,058). 2025 ASE updated recommendations vs. 2016 ASE guidelines was evaluated on Prevalence of left ventricular diastolic dysfunction. The 2025 ASE guidelines diagnosed left ventricular diastolic dysfunction in 29.3% of asymptomatic elderly inpatients versus 24.0% with the 2016 guidelines, eliminating all indeterminate cases.
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