Comparison of the 2016 and 2025 ASE/EACVI Guidelines on HFpEF
W HuAbstract
Background
The assessment of diastolic dysfunction in patients with preserved left ventricular ejection fraction (HFpEF) was clinically challenging. The 2025 ASE/EACVI guidelines for HFpEF was published recently and the diagnostic performance of it remains unclear.
Objectives
This study aimed to evaluate the diagnostic performance of the 2025 ASE/EACVI guidelines for HFpEF and compared it with that of the 2016 ASE/EACVI guidelines.
Methods
This study prospectively collected echocardiographic data and left atrial pressure (LAP) measurements from 119 patient. Patients were categorized into HFpEF (LAP >15 mmHg) and non-HFpEF (LAP ≤15 mmHg) groups. Both the 2016 and 2025 ASE/EACVI guidelines were applied to assess HFpEF using echocardiographic parameters.
Results
The 2025 guidelines demonstrated significantly higher sensitivity (86.4% [75.7–93.6] vs. 54.0% [39.3–68.2]) and feasibility (100% [ 98.0-100] vs. 78.1% [72.2-84.0]) but lower specificity (81.8% [73.8–88.2] vs. 94.8% [88.3–98.3]) and positive predictive value (72.2% [63.7–79.3] vs. 84.4% [68.9–92.9]) compared to the 2016 guidelines. Negative predictive value (91.7% [85.6–95.3] vs. 79.8% [74.5–84.3]) and overall accuracy (83.4% [77.3–88.5] vs. 80.8% [73.5–86.9]) improved modestly.
Conclusions
The 2025 guidelines significantly improved HFpEF feasibility and improved enhanced HFpEF detection rates and applicability while maintaining comparable accuracy.