Differential prognostic value of echocardiography and strain in HFrEF vs HFpEF at early post-acute reassessment

AIMS: To assess the prognostic value of echocardiographic and strain parameters, their early dynamics after acute HF hospitalisation, and potential differences in post-acute evolution between HFrEF (LVEF <50%) and HFpEF (LVEF ≥50%). METHODS: In this prospective study, 110 of 163 patients completed baseline and one-month reassessments. Measurements were analysed at baseline, follow-up, and as changes (Δ). Echocardiography included global longitudinal strain (GLS), right ventricular free wall strain (RVFW-LS), TAPSE/sPAP, and standard parameters; biomarkers comprised NT-proBNP and ST2 among others. Outcomes included a composite of HF readmission and cardiovascular death (MACE), and all-cause mortality. RESULTS: Mean age was 74.6 years; 63% men; 69 HFrEF and 41 HFpEF patients at admission. During 1.9 years follow-up, 50% were readmitted and one third died. Outpatient reassessment better predicted outcomes than admission values. Across the whole cohort, impaired TAPSE/sPAP, GLS, RVFW-LS (optimal >-16.3), and biomarkers predicted adverse outcomes. In HFrEF, favourable LV geometry, better GLS (<-11.4), and recovery in ΔGLS (>2) and ΔRVFW-LS (>1.8) were protective. In HFpEF, impaired GLS (>-16.6), RV dysfunction, and adverse right-sided remodelling predicted worse prognosis. In multivariable Cox analysis, ΔGLS, de novo HF, and NT-proBNP remained independent predictors in HFrEF (c-statistic 0.79). In HFpEF, ΔRA area and ST2 retained prognostic significance (c-statistic 0.75). CONCLUSION: Early post-discharge echocardiography, including biventricular strain, adds prognostic value in post-acute HF. Determinants differ by LVEF phenotype: strain recovery and less rigid LV geometry protect in HFrEF, whereas right-heart dysfunction and remodelling dominate in HFpEF. Short-term imaging reassessment may refine risk stratification and guide follow-up.