Abstract Background: Heart failure (HF) is a complex and fatal medical entity with high morbidity and mortality, Patients with HF have poor prognoses. Hospitalization for acute heart failure has a poor vital prognosis, with frequent subsequent readmis-sions [1]. Aim of Study: Determine the relation between left atrial strain and MACE during hospitalization and 3 months post discharge in patients admitted with acute decompensated heart failure. Patients and Methods: This was a prospective observa-tional study that included 90 patients hospitalized with acute heart failure where full history, clinical examination, and 2D transthoracic echocardiography with assessment of left atrial strain parameters were done to all patients, then patients were assessed for short term outcomes. Results: The mean ± SD age of our patients was 60.3±9.5 years. Seventy percent were males. Regarding Outcome follow-up (3 months) data; mortality occurred in 12.2% of patients, 55.6% needed re-admission, 46.7% had atrial fibrillation, and 40% had stroke. Different left atrial strain parameters were significantly associated with mortality, rehospitalization, inci-dence of atrial fibrillation and stroke. Conclusion: Our study had proven that LA strain param-eters (LA reservoir strain, LA contractile strain), had a signifi-cant prognostic value in predicting mortality, rehospitalization, and incidence of atrial fibrillation in acute decompensated heart failure patients. So, 2D speckle tracking echocardiography had a particular importance in acute heart failure prognosis prediction.