Reclassification of Diastolic Function by the 2025 American Society of Echocardiography Diastolic Function Guidelines...

Whether the 2025 American Society of Echocardiography (ASE) diastolic dysfunction (DD) algorithm (DD25) improves mortality prognostication compared to the 2016 algorithm (DD16) in real-world practice is uncertain.

We applied the DD25 algorithm to adult transthoracic echocardiography reports across a large academic multisite echocardiography laboratory from 2018 2024, linked to state mortality data, and determined reclassification of DD and mortality risk.

Of 12,948 included (age 62.8 ± 18.1, 51.4% women, 55.8% outpatient), 10,205 (78.8%) had diastology quantified by the 2016 and 2025 guidelines. Of these, 2,601 (25.5%) were reclassified by DD25 with increases in DD grade in 1,428 (54.9%) and decreases in 1,173 (45.1%). Among those reclassified, 2,391 (91.9%) had a single grade change in DD severity. A larger proportion of female patients (52% vs 48.7%) were classified as having DD by DD25 versus DD16. The rate of indeterminate DD was lower by DD25 (1,358 [10.4%]) vs DD16 (1,983 [15.3%]). The DD25 algorithm improved discrimination of mortality risk compared to DD16 (difference in areas under the curve = 0.02; 95% CI, 0.001-0.04; P = .03), although the magnitude of the associated risk across the follow-up period was similar after multivariable adjustment (P value for comparison of adjusted hazard ratios = .67).

In a large academic health system, one-quarter of patients had reclassification of diastolic function by the 2025 ASE diastology guidelines. As compared to the 2016 algorithm, the 2025 algorithm resulted in a larger proportion with DD, less indeterminate diastolic function, and improved discrimination of mortality.