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Related Concept Videos

Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

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Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Imaging Studies for Cardiovascular System I:Echocardiography01:17

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Cardiac imaging studies encompass a wide range of noninvasive and minimally invasive techniques designed to visualize the heart's structure and function in detail. One such technique is echocardiography, which uses high-frequency ultrasound waves to produce detailed images of the heart, known as echocardiograms.
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Imaging Studies for Cardiovascular System II:Types of Echocardiography01:20

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Echocardiography plays a role in assessing cardiac health and detecting heart conditions, with various types providing critical insights for diagnosis and treatment.
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Related Experiment Video

Updated: Jan 15, 2026

Echocardiographic Approaches and Protocols for Comprehensive Phenotypic Characterization of Valvular Heart Disease in Mice
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Echocardiographic Diastolic Function Grading in HFpEF: Testing the Updated 2025 ASE Criteria.

Tomonari Harada1, Hidemi Sorimachi2, Masaru Obokata2

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Journal of the American College of Cardiology
|January 14, 2026
PubMed
Summary

The 2025 American Society of Echocardiography (ASE) algorithm frequently misclassifies heart failure with preserved ejection fraction (HFpEF) patients, showing a high false-negative rate. Diastolic function grading requires careful interpretation alongside clinical context, not in isolation.

Keywords:
diagnosisdiastolic functionechocardiographyexerciseheart failure with preserved ejection fraction

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Evaluation

Background:

  • Echocardiography is crucial for diagnosing heart failure with preserved ejection fraction (HFpEF).
  • A new American Society of Echocardiography (ASE) algorithm for diastolic function needs evaluation in HFpEF.
  • Current diagnostic methods for HFpEF require systematic assessment.

Purpose of the Study:

  • To determine the false-negative rate of the 2025 ASE algorithm in ambulatory HFpEF.
  • To assess changes in diastolic grades between decompensated and recompensated HFpEF.
  • To compare the algorithm's diagnostic discrimination and prognostic associations with existing methods.

Main Methods:

  • Echocardiography was performed on ambulatory and hospitalized HFpEF cohorts.
  • Invasive hemodynamic exercise testing was used in ambulatory patients.
  • Noncardiac dyspnea controls were included for comparative analysis.

Main Results:

  • The 2025 ASE algorithm showed a 90.5% false-negative rate in HFpEF patients under stress.
  • A significant proportion of HFpEF patients with normal/low grades had elevated pulmonary artery wedge pressure.
  • The algorithm demonstrated poor discrimination between HFpEF and noncardiac dyspnea.

Conclusions:

  • The 2025 ASE algorithm has inadequate sensitivity for diagnosing HFpEF.
  • Echocardiographic diastolic grading should be interpreted within clinical context, not isolation.
  • Current algorithms require refinement for accurate HFpEF evaluation.