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Invasive validation of BSE-2024 vs. BSE-2013 using LVEDP and LV pre-A pressure in patients undergoing cardiac
Amer Barakat1, Ali Khaddam2, Mhd Ameen Alkhatib2
1Department of Cardiology, Damascus University, Fayez Mansour Street, Damascus, Syria. amerbarakat252@gmail.com.
Echo Research and Practice
|July 26, 2026
Summary
The 2024 British Society of Echocardiography (BSE) guidelines for diastolic function (DF) and left ventricular filling pressure (LVFP) show reduced sensitivity compared to 2013. A new algorithm offers a more balanced diagnostic profile for LVFP detection.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Diastolic function (DF) and left ventricular filling pressure (LVFP) are crucial for assessing cardiac health.
- Echocardiography is a primary non-invasive tool for estimating these parameters.
- Previous guidelines, like the 2013 British Society of Echocardiography (BSE) recommendations, have limitations in accuracy.
Purpose of the Study:
- To invasively validate the 2024 and 2013 BSE recommendations for DF and LVFP detection.
- To compare diagnostic performance against invasive measurements from left heart catheterization (LHC).
- To propose and evaluate a complementary algorithm for improved diagnostic accuracy.
Main Methods:
- A prospective multicenter study involving 716 patients in sinus rhythm undergoing clinically indicated LHC.
- Echocardiography was performed within 120 minutes prior to LHC.
- Diagnostic classifications from BSE guidelines and a proposed algorithm were compared with invasive LVEDP and LV pre-A pressures.
Main Results:
- BSE-2024 reduced indeterminate classifications but showed lower sensitivity (27.8% for LVEDP) compared to BSE-2013 (44.2%).
- Diagnostic discrimination for LVFP detection was comparable between guidelines (AUC for LVEDP: 0.602 vs. 0.630).
- The proposed complementary algorithm demonstrated robust performance in both derivation and validation cohorts, with balanced sensitivity and specificity (e.g., LVEDP: 88.3% sensitivity, 87.9% specificity in validation).
Conclusions:
- The BSE-2024 guidelines offer improved classification of indeterminate cases but exhibit reduced sensitivity for detecting impaired diastolic function and elevated filling pressures.
- The proposed complementary algorithm presents a more balanced diagnostic profile and warrants further external validation.
- Direct comparisons between guideline versions require careful interpretation due to differences in handling indeterminate cases.
