Performance da diretriz 2025 da av da função diastolica | EJC #075

Welcome to another edition of the Echo Journal Club, an echocardiography update program curated from the most relevant articles published in leading echocardiography journals. When the new 2025 ASE diastolic function guideline was published, many of us breathed a sigh of relief. After almost a decade dealing with the limitations and high rate of indeterminate results of the 2016 algorithm, we finally had a new flowchart that promised to modernize our practice and refine the diagnosis of HFpEF. But does this new algorithm really work when put to the test against the gold standard (catheterization) in the "real world"? This elegant retrospective study reveals an uncomfortable truth for echocardiographers: most patients with invasively confirmed HFpEF ended up being classified as having normal or grade 1 diastolic function. To make matters worse, even when these patients underwent diastolic stress echocardiography, the proposed criteria failed to identify the disease in an alarming 90% of invasively confirmed HFpEF cases! Given this, the question remains: are we using an algorithm that, instead of screening, may be blinding us and incorrectly excluding such a serious disease? The truth is that blindly relying on a flowchart can be a dangerous mistake, and this work reminds us that diastole is dynamic, dependent on hemodynamic status, and that the paramount clinical context should never be disregarded. If you want to understand the pitfalls of this new guideline and how to interpret it safely, be sure to watch this video. 📌 Watch the presentation and discussion by Dr. Felipe Oliveira of the article “Echocardiographic Diastolic Function Grading in HFpEF: Testing the Updated 2025 ASE Criteria”, published in JACC in 2026.