JASE

PLEASE NOTE: Beginning today, JASE will be available online only.

We previously developed an algorithm to improve classification of interatrial communications (IACs) in newborns. This @JournalASEcho study aimed to evaluate the patency at preschool age of neonatal IACs classified using the algorithm. bit.ly/4cSU2x2

@NadeenFaza @JGrapsa @JiwonKimMD @PWesslyMD @ASE360 @DavidWienerMD @rajdoc2005 @purviparwani @iamritu @JournalASEcho @nishath_quader @EGarciaSayan ANSWER 4-DEFINITION LV DIASTOLIC DYSFUNCTION (DD) 3️⃣ hallmarks of LV DD: ⬇️ LV relaxation and ⬆️ LV diastolic stiffness +/- ⬆️LVFP. Echo parameters rely on markers of ⬇️ LV relaxation, chamber remodelling & ⬆️ LVFP/LAP (see figure). #ASEchoJC @SNagueh @dysanborn @ASE360

Thank you for joining #ASEchoJC tonight as we decoded the updated @ASE360 Diastology Guidelines & tackled the complexities of diastolic function! 🫀📊Grateful to our incredible guest authors @SNagueh @dysanborn @BonitaEcho, my fantastic co-moderators @HeartToProve @PWesslyMD & our engaged audience for such a lively, thoughtful, & high-yield discussion. 🙏💬 Until next time! ✨ #EchoFirst #Cardiotwitter #CardioX

tinyurl.com/y4kfsnsx 🫀 New multicenter study (n=951) validates a stepwise echo algorithm to estimate LV filling pressure (LVFP) in patients evaluated for dyspnea. • Uses e′, E/e′, PASP first, then LA strain, LAVI, IVRT & pulmonary vein flow if discordant • Indeterminate results: 2 vs 38 with 2016 guidelines • Accuracy: 86% (sens 86%, spec 86%) • Adds incremental value beyond natriuretic peptides A promising approach to reduce “indeterminate” diastology. #EchoFirst #HFpEF #CardioTwitter #ASEchoJC

Check out this paper! H₂FPEF score helps rule out HFpEF when probability is <30%. However, when probability is >30%, incorporating echocardiographic parameters from the 2025 @ASE360 diastolic guidelines to estimate mean LAPsignificantly improves diagnostic accuracy vs H₂FPEF alone. 🫀📊 tinyurl.com/2h4mv9xy 👉 #EchoFirst adds meaningful reclassification & discrimination for HFpEF diagnosis. #HFpEF #EchoFirst #CardioTwitter #ASEchoJC

@NadeenFaza @SNagueh @dysanborn @BonitaEcho @PWesslyMD @iamritu @SIwa23288585 RECOMMENDED READ ON THIS SUBJECT "Improving the Diagnosis of HFpEF: A Comparison of the H2FPEF Score and the 2025 ASE Diastolic Function Guideline Recommendations Using Invasive Hemodynamics as the Gold Standard" #ASEchoJC jacc.org/doi/abs/10.101… @SFNagueh

@NadeenFaza @SNagueh @dysanborn @BonitaEcho @PWesslyMD @iamritu @SIwa23288585 Remember that HFpEF is a clinical diagnosis. It can be complex. Integrate all the tools at hand to make the correct diagnosis. #ASEchoJC

🔑 HFpEF is not an echocardiographic diagnosis alone. It requires: 🔹 HF symptoms 🔹 Preserved EF 🔹 Objective evidence of elevated filling pressures from echo, biomarkers, or hemodynamics ⚠️ Always exclude HFpEF mimics: CAD, infiltrative disease, HCM, constriction, significant VHD Diagnosis requires integration of clinical, imaging, and laboratory data. #ASEchoJC #EchoFirst @ASE360 #HFpEF

@NadeenFaza @dysanborn @BonitaEcho @PWesslyMD @HeartToProve @iamritu @SIwa23288585 #HFpEF #ASEchoJC #EchoFirst

@NadeenFaza @SNagueh @dysanborn @BonitaEcho @HeartToProve @iamritu @SIwa23288585 🫀 How do we diagnose HFpEF? A stepwise clinical approach—from symptoms to invasive hemodynamics. Quick visual guide 👇 #ASEchoJC #EchoFirst @ASE360

@NadeenFaza @SNagueh @dysanborn @BonitaEcho @HeartToProve @ASE360 🫀 AF diastology tip 💡 Look at beat-to-beat variability in mitral inflow 📉 Less variability in E velocity across cycles → suggests elevated LV filling pressure Record multiple beats at sweep speed ~50 mm/s to assess this pattern. #ASEchoJC #EchoFirst @ASE360

#ASEchoJC Q 10. How are echocardiographic findings integrated with clinical and laboratory data in the diagnosis of HFpEF? @SNagueh @dysanborn @BonitaEcho @PWesslyMD @HeartToProve

@NadeenFaza @SNagueh @dysanborn @BonitaEcho @HeartToProve @ASE360 ⚠️ No single echo parameter reliably estimates LAP in AF. A multiparametric approach is required. #ASEchoJC #EchoFirst @ASE360

@NadeenFaza @SNagueh @dysanborn @BonitaEcho @HeartToProve @ASE360 🫀 Diastology in Atrial Fibrillation — key challenge AF complicates LV filling pressure assessment due to: 🔹 Variable cycle length 🔹 Loss of atrial contraction 🔹 Tachycardia 🔹 Frequent LA enlargement #ASEchoJC #EchoFirst @ASE360

#ASEchoJC #EchoFirst #RCM

🫀 Echo pearl in AFib When estimating LV filling pressure: 🔹 Average measurements from multiple cardiac cycles 🔹 Select cycles reflecting the average heart rate 📌 Dual Doppler (simultaneous E & e′ from the same beat) improves accuracy when calculating E/e′. #ASEchoJC #EchoFirst @ASE360

@NadeenFaza @SNagueh @dysanborn @BonitaEcho @HeartToProve @ASE360 🫀 Cardiac amyloidosis echo pearl Advanced disease may show the “5-5-5 sign”: 🔹 S′ <5 cm/s 🔹 e′ <5 cm/s 🔹 a′ <5 cm/s All mitral annular velocities <5 cm/s due to severe myocardial infiltration. #ASEchoJC #EchoFirst @ASE360

🫀 Restrictive cardiomyopathy pearl Restrictive physiology = rapid rise in LV diastolic pressure with minimal change in LV volume due to marked myocardial stiffness. ⚠️ Restrictive LV filling ≠ restrictive cardiomyopathy. Restrictive filling can also occur in CAD, DCM, and HCM. #ASEchoJC #EchoFirst @ASE360

🧵 HCM diastology pearls 🔹 Impaired LV relaxation can precede LV hypertrophy in genotype-positive individuals. 👉 Diastolic dysfunction may be an early phenotypic marker of HCM. 💡 Symptoms in HCM are not always due to LVOT obstruction. Diastolic dysfunction often drives dyspnea and exercise intolerance even without obstruction. #ASEchoJC #EchoFirst @ASE360

@PWesslyMD @NadeenFaza @SNagueh @dysanborn @BonitaEcho @ASE360 #ASEchoJC