2025 ASE Diastolic Grading in HFpEF

Background: Patients with early stage heart failure with preserved ejection fraction (HFpEF) frequently develop hemodynamic abnormalities only with exercise. The 2025 American Society of Echocardiography (ASE)-diastolic algorithm considers grade 1 diastolic dysfunction (DD) to indicate normal left ventricular (LV) filling pressure. In dyspneic patients with grade 1 DD, exercise stress echocardiography (ESE) is recommended to diagnose hidden HFpEF. Objective: To test the ability of the 2025 ASE algorithm to diagnose HFpEF using invasive exercise testing as the gold standard. Design: Retrospective cohort study. Methods: Echocardiography was performed in 2 HFpEF cohorts: (1) ambulatory patients with compensated heart failure (HF) who underwent invasive hemodynamic exercise testing in a prospective cohort study, including an external validation cohort; and (2) hospitalized patients with decompensated HF, both during acute episodes and after recompensation. Secondary analyses included non more...