WATCH: Refining Diastolic Function Diagnosis: Insights from the Recently Updated ASE Guidelines

Clinical assessment of diastolic function continues to evolve as new evidence clarifies how physiologic aging and disease intersect with echocardiography. In this video, Dr. Sherif Nagueh, medical director of the Echocardiography Laboratory at Houston Methodist, discusses the development and rationale behind the 2025 diastolic function guideline updates from the American Society of Echocardiography, of which he chaired.

"As the chair, you assemble the data, you discuss with the different working group members their point of views and opinions and [use the data to make] recommendations that are well supported by evidence," Dr. Nagueh says. "So [as the chair], you play a role in bringing the different opinions together to a consensus."

Building on prior guideline iterations, the latest recommendations aim to better identify true disease while reducing misclassification in everyday practice.

Key highlights:

• Greater emphasis on age‑related changes in diastolic parameters. The updated recommendations underscore the importance of accounting for age‑induced changes when interpreting diastolic function indices, recognizing that normal aging can influence commonly used parameters and affect diagnostic thresholds.

• Introduction of a new algorithm to estimate left atrial pressure. A major update includes a revised algorithm for estimating left atrial pressure that was tested in a large study of 950 patients, strengthening confidence in its clinical applicability and diagnostic accuracy.

• Expanded guidance on the role of echocardiography in HFpEF diagnosis. The guidelines now include clearer recommendations on how imaging — particularly echocardiography — should be used to support the diagnosis of heart failure with preserved ejection fraction, a common and often challenging clinical condition.

• Focus on avoiding both under‑ and over‑diagnosis. A central goal of the updated recommendations is to identify patients who truly have disease while avoiding labeling individuals without disease as pathologic, improving diagnostic precision at the point of care.

• Clinical implications for prevention and treatment planning. More accurate identification of diastolic dysfunction enables clinicians to appropriately direct preventive strategies and, when indicated, initiate or refine treatment approaches to deliver better patient care.