Funding Acknowledgements NA Background Despite advancements in medical therapy and device-based treatment, heart failure (HF) continues to impose enormous burden for both patients and health care system worldwide. Hospitalizations due to HF decompensation is well-known cause of mortality. Objectives were to verify whether 2D speckle tracking echocardiography (2D STE) provides independently of other well-known clinical and echocardiographic parameters, information on the risk of HF decompensation in patients with left ventricular systolic dysfunction of ischemic origin. Materials and Methods In 193 stable ischemic HF patients with left ventricular ejection fraction (LVEF) ≤ 50%, global longitudinal strain (GLS), as well as other echocardiographic (GE VIVID E9, EchoPAC v201) and well-known clinical parameters were analyzed. During 34 (14 – 71) months of follow-up, 58 patients were hospitalized due to HF decompensation (EVENT). Results LVEF, GLS, diastolic function and well-known clinical parameters (age, renal function, hemoglobin, brain natriuretic peptide level, history of diabetes, diuretic treatment and the absence of beta-blockers), as well as cut-off values of these parameters identified in ROC analysis were significantly associated with the risk of EVENT in univariate Cox hazard regression analysis (Table). GLS value of -9.4% was the most accurate predictor of EVENT (AUC 80.7% [CI 57.6 – 100%]), whereas other parameters were characterized by lower discriminatory power. In multivariate Cox analyses GLS of -9.4% was still a significant predictor of the EVENT. Conclusions 2D STE can provide additional information, independently of other well-known clinical and echocardiographic parameters, on the risk of HF decompensation in the patients with left ventricular systolic dysfunction of ischemic origin. GLS value worse than -9.4% can identify the patients with higher risk of this EVENT. Hazard Ratio 95% CI p Age ≥ 71 yo 2.48 1.46 - 4.23