Heart failure (HF) is a life-threatening condition, with an important socio-economic burden. Its prevalence increases with age. Numerous models have been proposed to estimate the prognosis in acute HF (AHF) but none is based on echocardiography.

The aim of this study was to identify the prognostic value of echocardiographic parameters in AHF among the elderly.

This was a prospective, monocentric, observational study, conducted from December 2020 to December 2022 in the Cardiology Department of our hospital. We included all the patients aged of 65 years and above hospitalized for AHF. All patients had an echocardiography with a comprehensive assessment of the cardiac function. Primary endpoint was 18-month all cause-mortality or rehospitalization for AHF, secondary endpoints were 18-month all cause-mortality and rehospitalization for AHF.

The study cohort included 93 patients (68% men). The mean age was 72±5 years. Diabetes and hypertension were the most common cardiovascular risk factors, being found in 70% and 69% of patients, respectively. The most common etiology of HF was ischemic, which represented 64% of all etiologies. During follow-up, 55% of the patients died or were rehospitalized for AHF, all-cause mortality occurred in 23.6% of patients and 45% were rehospitalized. In multivariate analysis, only right ventricular(RV) free-wall strain with a cut-off value of –19% (OR=13, 95%CI: 4.8–35, p=0.001) was an independent predictor for all-cause mortality or rehospitalization for AHF. Right ventricular fractional area change (RV-FAC) with a cut-off value of 30% (OR=8.47, CI: 2.86–25, p=0.001) was an independent predictor for all-cause mortality. The tricuspid annular plane systolic excursion (TAPSE) and left ventricular global longitudinal strain (LV-GLS) were independent predictors for rehospitalization with a cut-off value of 16mm (OR=3.18, 95%CI 1.25–8.04, p=0.013) and –11% (OR=2.98, 95%CI 1.22–7.22, p=0.014), respectively.

Right ventricular function parameters seem to be strong echocardiographic predictors of mortality and rehospitalization in elderly patients with AHF. An early intensive management may improve the prognosis of these patients.