ABC Imagem Cardiovasc. 2026; 39(1): e20260004
Recalibrating the Barometer: Echocardiography in Diastolic Dysfunction and the Era of New Algorithms
DOI: 10.36660/abcimg.20260004i
Diastolic dysfunction (DD) remains a diagnostic challenge, not for lack of available parameters, but because uncertainty emerges when complex physiology is reduced to static labels in echocardiographic reports. In clinical practice, physicians are often less concerned with the specific grade of DD and more interested in its prognostic implications and in whether increased filling pressures may explain dyspnea, guide further investigation, and support therapeutic decisions. It is precisely in this variable, mean left atrial pressure (MLAP) and left ventricular (LV) filling pressure (LVFP), that echocardiography must be most pragmatic, minimizing the number of “indeterminate” reports and offering an operational conclusion grounded in integrated physiology.–
The structured reasoning that supports this goal began with the 2009 American Society of Echocardiography/European Association of Echocardiography guideline on the evaluation of LV diastolic function, a landmark document that organized modern thinking on diastole, established a shared language for key pathophysiological mechanisms, and systematized the interpretation of echocardiographic parameters. Beyond its conceptual value, it reinforced a critical principle for echocardiography laboratories: the assessment of diastole must translate into a clinically meaningful message, particularly when heart failure with preserved ejection fraction (HFpEF) is suspected.
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