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Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Al-mouwasat University Hospital and University Heart Surgery Center in Damascus, Syrian Arab Republic. Background Left ventricular diastolic function assessment undergoes continuous updates. EACVI/ASE 2016 guidelines handles with this case, which is an expert consensus and simplified update of the 2009 recommendations. As stated in the latest guidelines, studies need to check that the simplicity does not affect much the accuracy. Aim This study compares the corresponding subgroups between the 2009 and 2016 EACVI/ASE guidelines, for the assessment of left ventricular diastolic function statistically. Furthermore, it invasively validates of the relation between the grading results of each guidelines and  the measured LV filling pressure during catheterization lab. Methods 124 patients underwent transthoracic echocardiography just before angiography. A trained echo cardiographer obtained E/A mitral flow, Av E/e", LAVI, TR, septal and lateral e" and other supportive parameters to assess LV diastolic function and filling pressure according to 2009 and 2016 EACVI/ASE guidelines algorithms and we compared the results with LV pre-a wave during catheterization with a cut-off &amp;gt;12mmhg considered elevated. Results EACVI/ASE 2016 resulted in {normal (46.77%), Grade I (29.03%), Grade II (10.48%), Grade III  (7.26%) and indeterminate (6.45%)}, while EACVI/ASE 2009 resulted in {normal (39.52%), Grade I (25%), Grade II (13.71%), Grade III  (7.26%) and indeterminate (14.52%)} with no statically significant difference between subgroups. EACVI/ASE 2016 vs. 2009 in assessment LV filling pressure (odds ratio =0.51 and p value = 0.034. EACVI/ASE 2016 sensitivity and specificity were (0.36, 0.94 ) respectively and EACVI/ASE 2009 sensitivity and specificity were (0.63, 0.80) respectively. All results are summarized in (tables: 1 + 2+3 + 4+5 + 6). Conclusion This study found that the updated and simplified 2016 EACVI/ASE guidelines algorithm did not affect statistically the grading results of 2009 EACVI/ASE. Even more, 2016 had a higher relation between diastolic subgroups and invasively measured LV filling pressure which reflects the higher specificity than 2009. On the other hand 2016 was less able to detect elevated LV filling pressure which reflects a lower sensitivity than 2009. 2016 was more specific but less sensitive than 2009. There were no statistically significant difference between the means of invasively measured LV filling pressures among both guidelines. Abstract Figure.  Abstract Figure.

A check of the grading system among the 2009 and 2016 EACVI/ASE left ventricular diastolic function guidelines statistically and invasively