Diastolic Function Assessment in 2025

Background

Diastolic dysfunction—impaired relaxation and filling of the left ventricle (LV)—is a major contributor to heart failure with preserved ejection fraction (HFpEF). Accurate assessment is essential for diagnosis and management, especially in patients presenting with dyspnea or exercise intolerance.

Updated Diagnostic Algorithms

The American Society of Echocardiography (ASE) released new guidelines in 2025 that refine and expand upon the 2016 ASE/EACVI recommendations:

• Step 1: Assess LV relaxation
  • Septal e′ ≤ 6 cm/s or lateral e′ ≤ 7 cm/s
  • Average e′ ≤ 6.5 cm/s
• Step 2: Evaluate markers of elevated left atrial pressure (LAP)
  • E/e′ > 14
  • LA reservoir strain (LARS) ≤ 18%
  • E/A ratio ≤ 0.8 or ≥ 2
  • LA volume index (LAVI) > 34 ml/m²
• Diagnosis Criteria
  • Diastolic dysfunction is present if:
    • e′ is reduced + ≥1 marker from Step 2
    • e′ is preserved + ≥2 markers from Step 2

New Parameters Introduced

• Left atrial strain (LA strain): A sensitive marker for elevated LV filling pressures.
• AI-enhanced interpretation: Integration of artificial intelligence for automated grading and prediction.
• Diastolic stress echocardiography: Recommended for exercise-induced symptoms and borderline cases.

Clinical Implications

• Improved HFpEF diagnosis: Earlier and more accurate identification of patients with preserved EF but symptomatic heart failure.
• Reduced need for invasive testing: Non-invasive algorithms now offer reliable LAP estimates, minimizing reliance on catheterization.
• Tailored recommendations: Separate guidance for special populations (e.g., atrial fibrillation, pulmonary hypertension, transplant patients).

References

1. American Society of Echocardiography Guidelines
2. European Society of Cardiology Guidelines
3. PubMed - Diastolic Function Research