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 -16.3), and biomarkers predicted adverse outcomes. In HFrEF, favourable LV geometry, better GLS (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.