Introduction: Higher left ventricular filling pressure (LVFP) is often associated with non-fluid responsiveness in heart failure patients, particularly those with reduced ejection fraction. This hemodynamic state has been linked to adverse outcomes, including higher rates of rehospitalization and mortality. However, the prognostic implications of fluid responsiveness assessed after decongestion remain uncertain.

Aims: To explore the relationship between fluid responsiveness and short-term outcomes in patients with heart failure and reduced ejection fraction, by assessing changes in the Velocity Time Integral (VTI), measured at LVOT using apical 5-chamber view via echocardiography during the passive leg raising (PLR) maneuver.

Methods: This prospective observational analytical cohort study enrolled patients with acute heart failure reduced ejection fraction who were hospitalized for decongestion at Adam Malik Hospital between December 2024 and March 2025. Fluid responsiveness was defined as an increase in VTI of ≥10% before and after performing the PLR. The relationship between fluid responsiveness and the outcomes of rehospitalization and mortality at 30 days and 3 months was analyzed using the Chi-square test.

Results: Among 65 enrolled patients, 37 (57%) were classified as non-fluid responders (NFR). Within 30-day after discharge, 4 (10.8%) patients were rehospitalized, and 2 (5.4%) patients died. Within 3-months after discharge, 8 (21.6%) patients were rehospitalized, and 7 (18.5%) patients died. Twenty-eight (43%) were classified as fluid responders (FR). Within 30-day after discharge, 4 (14.3%) patients were rehospitalized and 3 (10.7%) patients died. Within 3-months after discharge, 2 (7.1%) patients were rehospitalized, and 5 (17.9%) patients died. No statistically significant differences in rehospitalization or mortality rates at either 30 days or 3 months between two groups. Event rates showed overlapping patterns across fluid responsiveness categories.

Conclusions: In this exploratory analysis, fluid responsiveness assessed by PLR was not associated with short-term rehospitalization or mortality in decongested patients with HFrEF. Given the limited statistical power, these findings should be interpreted as hypothesis-generating rather than confirmatory, and further adequately powered studies are warranted to clarify the prognostic role of PLR-derived fluid responsiveness in this population.

Acute heart failure reduced ejection fraction, Fluid responsiveness, Mortality, Passive leg raising, Rehospitalization