What is the clinical evidence from this study?

Study design: Cohort. Population: Left ventricular diastolic dysfunction (LVDD) (n=1953). Intervention: 2025 ASE guidelines for LVDD classification vs. 2016 ASE guidelines. Primary outcome: Major adverse cardiovascular events (p==0.02).

May 14, 2026

Impact of the 2025 ASE Guidelines on the Classification of LV Diastolic Dysfunction in the Community: A Project Baseline Health Study

Key Result

The 2025 ASE recommendations identified more participants with LVDD than the 2016 algorithm and were significantly associated with major adverse cardiovascular events (overall MACE rate 5.0%).

Study Design

Type

Cohort (n=1,953)

Structured PICO

Does the 2025 ASE classification of LVDD improve identification and maintain prognostic value for major adverse cardiovascular events compared to the 2016 classification in a community cohort?

Population

1,953 participants from the Project Baseline Health Study who underwent comprehensive transthoracic echocardiography

Intervention

Classification of left ventricular diastolic dysfunction (LVDD) using the 2025 American Society of Echocardiography (ASE) recommendations (evaluating both fixed and age-specific thresholds)

Comparator

Classification of LVDD using the 2016 ASE recommendations

Outcome

Major adverse cardiovascular events (MACE) over a median follow-up of 4.3 yearshard clinical

The updated 2025 ASE guidelines for LVDD successfully eliminate indeterminate classifications, identify more affected individuals in the community, and maintain independent prognostic value for major adverse cardiovascular events.

Main Result

p-value: p==0.02

Abstract

BACKGROUND: The 2016 American Society of Echocardiography (ASE) guidelines for left ventricular diastolic dysfunction (LVDD) classification resulted in a significant proportion of indeterminate classifications and grades. To address these limitations and incorporate new evidence, the ASE updated its recommendations in 2025. The impact of these revisions in community cohorts remains unclear. METHODS: We studied 1953 Project Baseline Health Study participants who underwent comprehensive transthoracic echocardiography. LVDD was classified using the 2016 and 2025 ASE recommendations. For the 2025 recommendations, fixed and age-specific thresholds were evaluated separately. We compared LVDD prevalence, reclassification patterns, associations with cardiovascular risk factors, and prognostic value for major adverse cardiovascular events over a median follow-up of 4.3 years. RESULTS: =0.02). Major adverse cardiovascular events occurred in 98 (5.0%) participants over the follow-up period. LVDD by all classification approaches was independently associated with major adverse cardiovascular events after adjustment for baseline risk factors. CONCLUSIONS: The 2025 ASE recommendations identified more participants with LVDD than the 2016 algorithm without indeterminate classification or grading. LVDD by the 2025 classification was significantly associated with major adverse cardiovascular events, supporting the clinical relevance of the revised framework.