A simplified, tier-based method for clinical evaluation of diastolic function
Edgar Argulian1, Sherif F Nagueh2, Julia Grapsa3
1Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, New York, NY 10025, USA.
Insights
This review simplifies assessing left ventricular diastolic function using the 2025 American Society of Echocardiography guidelines. It offers a probabilistic framework for improved clinical interpretation and consistent application in practice.
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Background:
- Assessing left ventricular diastolic function is complex and faces challenges with terminology, load dependence, and integrating discordant echocardiographic parameters.
- Consistent clinical application requires simplification of current assessment methods.
Purpose of the Study:
- To present a simplified, clinically oriented approach to diastolic function assessment based on contemporary imaging guidelines, focusing on the 2025 American Society of Echocardiography recommendations.
- To enhance clinical relevance, interpretive confidence, and consistent application of diastolic function assessment in routine practice.
Main Methods:
- Review of contemporary imaging guidelines for diastolic function assessment, emphasizing the 2025 American Society of Echocardiography recommendations.
- Application of a probabilistic diagnostic framework integrating clinical context, echocardiographic findings, and advanced imaging.
- Discussion of emerging artificial intelligence-based approaches for diastolic dysfunction assessment.
Main Results:
- A simplified, probabilistic framework is proposed for diastolic function assessment.
- Integration of clinical context and advanced imaging improves diagnostic accuracy.
- Artificial intelligence approaches offer potential for enhanced diagnostic and prognostic assessment.
Conclusions:
- The proposed pragmatic approach aims to improve the consistency and confidence in assessing diastolic function in clinical practice.
- Contemporary guidelines and advanced imaging, including AI, are crucial for accurate diastolic function evaluation.
- Simplification of assessment protocols is key for widespread clinical adoption.
Abstract:
Assessment of left ventricular diastolic function is inherently complex, yet it must be sufficiently simplified for consistent application in clinical practice. Interpretation is challenged by overlapping terminology, load dependence of haemodynamic variables, and the need to integrate multiple echocardiographic parameters that are often discordant. This review presents a simplified, clinically oriented approach to applying contemporary imaging guidelines for diastolic function assessment, with a focus on the 2025 American Society of Echocardiography recommendations. A probabilistic diagnostic framework is emphasized, integrating clinical context, echocardiographic findings, and advanced imaging when appropriate. There are emerging artificial intelligence-based approaches that conceptualize diastolic dysfunction as a latent phenotype, integrating multidimensional imaging and clinical data to improve diagnostic and prognostic assessment beyond traditional stepwise algorithms. The pragmatic approach described in the current review aims to enhance clinical relevance, improve interpretive confidence, and facilitate consistent application of diastolic function assessment in routine practice.
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