Diastolic Function Classification in Acute Myocardial Infarction: Comparison of the 2016 ASE/EACVI Guideline and the 2025 ASE Recommendations-Uncorrected Proof

Objective: Diastolic dysfunction (DD) and elevated left ventricular filling pressure (LVFP) commonly occur after acute myocardial infarction (MI) and are associated with adverse clinical outcomes. This study aimed to compare the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) guideline and the 2025 American Society of Echocardiography (ASE) recommendations for assessing diastolic function (DF) in patients with acute MI.

Method: This prospective, single-center, observational study included consecutive patients admitted with acute MI between November 2025 and April 2026. Comprehensive transthoracic echocardiography (TTE) was performed during hospitalization in the coronary intensive care unit (CICU). The presence of DD, LVFP categorization, and DD grading were evaluated according to both the 2016 ASE/EACVI guideline and the 2025 ASE recommendations. Agreement between the two algorithms was assessed using Cohen’s kappa analysis.

Results: A total of 99 patients were included (mean age, 59.3±12.2 years; 82.8% male). According to the 2016 guideline, DD status remained indeterminate in 3 patients and LVFP categorization remained indeterminate in 13 patients, whereas all patients could be classified using the 2025 recommendations. Among the patients who could be classified using both algorithms, 18 patients classified as having DD according to the 2016 guideline were reclassified as having normal diastolic function according to the 2025 recommendations (P < 0.001). Agreement between the two approaches was substantial for LVFP categorization (Cohen’s kappa=0.721, P < 0.001) and moderate for DD grading (weighted Cohen’s kappa=0.606, P < 0.001).

Conclusion: In patients with acute MI, the 2025 ASE recommendations reduced the number of indeterminate DF classifications and resulted in lower DD grades than the 2016 ASE/EACVI guideline while maintaining substantial agreement for LVFP categorization.

Keywords: Diastolic dysfunction, diastolic grading, echocardiography, left ventricular filling pressure, myocardial infarction