Key result
2025 ASE/EACVI guidelines show ~32-point higher HFpEF sensitivity compared to 2016 criteria.
Why the study?
Assessing diastolic dysfunction in patients with preserved LVEF is clinically challenging, and the diagnostic performance of the recently published 2025 ASE/EACVI guidelines for HFpEF compared with the 2016 guidelines remained unclear.
Does the 2025 ASE/EACVI guideline improve the diagnostic performance for detecting HFpEF (LAP >15 mmHg) compared to the 2016 ASE/EACVI guideline in patients with preserved left ventricular ejection fraction?
Observational (n=119)
Does the 2025 ASE/EACVI guideline improve the diagnostic performance for detecting HFpEF (LAP >15 mmHg) compared to the 2016 ASE/EACVI guideline in patients with preserved left ventricular ejection fraction?
The 2025 ASE/EACVI guidelines significantly improve echocardiographic feasibility and sensitivity for detecting elevated left atrial pressure in HFpEF compared to the 2016 guidelines, while maintaining comparable overall diagnostic accuracy.
May enhance HFpEF detection in preserved EF; extends 2016 guidelines but leaves open need for outcome validation before routine adoption.
Background The assessment of diastolic dysfunction in patients with preserved left ventricular ejection fraction (HFpEF) was clinically challenging. The 2025 ASE/EACVI guidelines for HFpEF was published recently and the diagnostic performance of it remains unclear. Objectives This study aimed to evaluate the diagnostic performance of the 2025 ASE/EACVI guidelines for HFpEF and compared it with that of the 2016 ASE/EACVI guidelines. Methods This study prospectively collected echocardiographic data and left atrial pressure (LAP) measurements from 119 patient. Patients were categorized into HFpEF (LAP >15 mmHg) and non-HFpEF (LAP ≤15 mmHg) groups. Both the 2016 and 2025 ASE/EACVI guidelines were applied to assess HFpEF 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 HFpEF feasibility and improved enhanced HFpEF detection rates and applicability while maintaining comparable accuracy.figure 1figure 1
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W Hu (2026) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) / diastolic dysfunction (n=119). 2025 ASE/EACVI guidelines for HFpEF vs. 2016 ASE/EACVI guidelines for HFpEF was evaluated on Diagnostic sensitivity for HFpEF (defined as left atrial pressure >15 mmHg). The 2025 ASE/EACVI guidelines demonstrated higher sensitivity (86.4% vs. 54.0%) and feasibility (100% vs. 78.1%) for diagnosing HFpEF compared to the 2016 guidelines, with 83.4% vs. 80.8% accuracy.
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