Diastolic Dysfunction Reclassification Following Implementation of the 2025 Echocardiographic Guidelines

Echocardiographic grading of diastolic dysfunction influences diagnosis, risk assessment, and longitudinal management in cardiovascular disease.

Updated 2025 diastolic dysfunction criteria emphasize integrated assessment of transmitral inflow, tissue Doppler indices, left atrial volume, tricuspid regurgitation velocity, and filling pressure estimates. Their implementation may alter classifications assigned using older criteria.

We performed a retrospective quality improvement analysis of 99 echocardiograms obtained from Syngo, a cardiovascular imaging and structured reporting platform, including 33 patients each with previous grade I, II, and III diastolic dysfunction. Each study was reassessed using the 2025 criteria and compared with the original grade. Forty-eight patients (48.5%) remained unchanged, whereas 51 (51.5%) were reclassified. Among reclassified patients, 19 (37.3%) were reclassified to a higher severity grade and 32 (62.7%) to a lower severity grade.

Applying contemporary criteria changed diastolic dysfunction grading in more than half of cases, most often toward lower severity.