David Winchester (@drdavemd.bsky.social)

Impact of routine repeat echocardiograms in patients hospitalized with acute decompensated heart failure without clear secondary cause - The International Journal of Cardiovascular Imaging Transthoracic echocardiography (TTE) at the time of acute decompensated heart failure (ADHF) may reveal significant structural and hemodynamic abnormalities that can guide clinical management. However, the impact of routine repeat TTE in uncomplicated ADHF re-admissions is yet to be established. We studied patients with repeat TTE at the time of rehospitalization for ADHF to determine downstream clinical impact. In a single center retrospective study, 410 adult patients with 2 ADHF admissions within 1 year were studied. 185 patients met inclusion criteria. Demographics, key echocardiography parameters and clinical changes were collected between first and second TTE. The study population comprised predominantly of Caucasians (55.7%) and males (53%). Non-ischemic cardiomyopathy was the principal etiology of heart failure. Between first and second TTE, there were no statistically significant changes noted in left ventricular ejection fraction, right ventricular systolic pressure, right atrial pressure, E/e ratio, or diastolic function. Right ventricular function was noted to significantly worsen as seen on the second TTE (p < 0.001). Mitral and aortic regurgitation was noted to be less severe in the repeat TTE group (p = 0.030 and p = 0.047, respectively). The predominant impact of repeat TTE in rehospitalized ADHF patients was medication changes rather than significant interventions, such as advanced imaging or invasive procedures. Our study demonstrates that clinicians should focus on reserving utilization of repeat TTE in uncomplicated ADHF readmissions to those not responding to standard medical optimization including diuresis. Major effect on downstream interventions and new diagnosis is not significantly impacted by repeating TTE. Graphical abstract Parts of the figure were drawn by using pictures from Servier Medical Art. Servier Medical Art by Servier is license under a Creative Commons Attribution 3.0 Unported License. https://link.springer.com/article/10.1007/s10554-025-03498-4