Echocardiography-Based Predictors of Outcomes in Hospitalized Patients With Decompensated Heart Failure (ECHO-DECOMP)

Acute decompensated heart failure is a leading cause of hospitalization and is associated with high morbidity and mortality. Early risk stratification in this population is crucial for guiding treatment strategies and predicting short- and long-term clinical outcomes. Transthoracic echocardiography is routinely performed in patients hospitalized with acute decompensated heart failure and provides comprehensive information regarding cardiac structure and function. However, the prognostic value of detailed echocardiographic parameters obtained before the initiation of intravenous diuretic therapy has not been fully clarified. The objective of this prospective study is to evaluate the prognostic significance of transthoracic echocardiographic findings obtained at hospital admission, prior to intravenous diuretic therapy, in patients hospitalized with acute decompensated heart failure. The study will assess key echocardiographic parameters reflecting left and right heart structure and function, including left ventricular ejection fraction, left ventricular dimensions and geometry, left atrial size and volume, indices of right ventricular systolic function (such as TAPSE, tissue Doppler-derived S' velocity, and fractional area change), pulmonary artery systolic pressure, right ventricular-pulmonary artery coupling assessed by the TAPSE/PASP ratio, and right ventricular outflow tract acceleration time. Primary outcome measures include in-hospital mortality, post-discharge mortality, myocardial infarction, ischemic stroke, and heart failure-related rehospitalization. Secondary outcomes include the need for non-invasive or invasive mechanical ventilation during hospitalization, requirement for inotropic support, changes in B-type natriuretic peptide levels, development of acute kidney injury, and occurrence of new-onset cardiac arrhythmias. By prospectively evaluating echocardiographic parameters and their associations with clinical outcomes, this study aims to clarify the prognostic role of early echocardiographic assessment in acute decompensated heart failure and to contribute to improved risk stratification and clinical decision-making in this high-risk population.