Objective:

To evaluate the impact of the 2025 American Society of Echocardiography diastolic function grading guidelines compared to the 2016 guidelines.

Approach:

• Study Design: A retrospective, single-center cohort study analyzing 300,828 adult transthoracic echocardiograms performed between 2013 and 2022.
• Data Analysis: Both 2016 and 2025 diastolic function grading algorithms were applied to echocardiograms, with a total of 87,724 studies meeting criteria for analysis.
• Statistical Modeling: A multiple logistic regression model was created to predict upgraded diastolic dysfunction based on demographic and clinical characteristics.

Key Findings:

• 20.1% of echocardiograms received different diastolic function grades under the 2025 guidelines.
• 14.0% of studies were upgraded, 6.1% were downgraded, and 79.9% remained unchanged.
• The proportion of studies classified as having normal diastolic function decreased from 78.9% (2016) to 73.8% (2025).
• Grade 1 diastolic dysfunction increased from 11.9% to 15.7%, Grade 2 from 6.4% to 8.4%, while Grade 3 decreased from 2.7% to 2.0% under the new guidelines.
• Older age, female sex, and higher left ventricular systolic function were associated with increased diastolic dysfunction grading using the 2025 guidelines.

Interpretation:

More studies were classified as having diastolic dysfunction under the 2025 guidelines compared to the 2016 guidelines.

Limitations:

• The study was conducted at a single center, which may limit generalizability.
• Disclosures were not reported in the supplied abstract text.

Conclusion:

The 2025 guidelines result in a higher classification of diastolic dysfunction compared to the 2016 guidelines.

Sources:

• Journal of the American Society of Echocardiography