Echocardiographic Predictors of Readmission and Mortality in Elderly Patients With Heart Failure and Preserved Ejection Fraction: A Prospective Observational Study.

Introduction Heart failure with preserved ejection fraction (HFpEF) is a major cause of hospitalization in the elderly, associated with high morbidity and recurrent admissions despite preserved left ventricular ejection fraction (LVEF ≥50%). Traditional echocardiographic markers may not adequately reflect the underlying myocardial dysfunction. Advanced indices such as global longitudinal strain (GLS), left atrial (LA) reservoir strain, early mitral inflow to early diastolic mitral annular velocity (e/e') ratio, and the tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio offer better prognostic insight. This study aimed to evaluate the predictive value of these echocardiographic parameters in determining mortality and heart failure readmissions over a 12-month period in elderly HFpEF patients. Study A prospective observational study was conducted at Stanley Medical College, Chennai, from February 2023 to December 2024. A total of 220 patients aged ≥60 years, admitted with acute decompensated HFpEF, were included. Standard and advanced echocardiography were performed within 72 hours of stabilization. Parameters measured included GLS, LA reservoir strain, E/e' ratio, LA volume index, TAPSE, and PASP. Patients were followed up at 30 days, 90 days, six months, and one year for readmission and mortality outcomes. Statistical significance was set at p<0.05. Results The mean age of the patients was 68.4±6.2 years; 126 patients (57.3%) were men. Impaired GLS (< -16%) was found in 138 patients (62.7%), reduced LA strain (< 23%) in 143 (65.0%), elevated E/e' (>15) in 157 (71.4%), and abnormal TAPSE/PASP (< 0.42) in 81 (36.8%). At 12 months, 129 patients (58.6%) had at least one readmission, and 41 patients (18.6%) had died. GLS < -16% was associated with 91 readmissions (65.9%) and 23 deaths (16.7%) vs. 38 readmissions (46.3%) and 18 deaths (22.0%) in the GLS >-16 group. Patients with LA strain < 23% had 95 readmissions (66.4%) and 25 deaths (17.5%) vs. 34 (44.2%) and 16 (20.8%) patients with LA stain >23%. Elevated E/e' >15 predicted 103 readmissions (65.6%) and 31 deaths (19.7%) vs. 26 (41.3%) and 10 (15.9%) in those having E/e' ≤15. TAPSE/PASP <0.42 was linked to 66 readmissions (81.5%) and 19 deaths (23.5%) compared to 63 readmissions (45.3%) and 22 deaths (15.8%) in those with TAPSE/PASP ≥0.42. All associations were statistically significant. Conclusion Advanced echocardiographic markers - GLS, LA reservoir strain, E/e', and TAPSE/PASP - were strong predictors of one-year readmission and mortality in elderly HFpEF patients. These indices offer superior risk stratification compared to conventional parameters and may guide post-discharge planning. Incorporating them into routine inpatient evaluation could improve outcomes through early identification of high-risk individuals and targeted follow-up strategies.