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The role of wave reflections in the pathogenesis of acute heart failure syndrome (AHFS) remains unclear. The present study investigated the long-term prognostic values of the carotid augmentation index (cAI), carotid augmented pressure (cAP), amplitude of the reflected pressure wave from a decomposed carotid pressure wave (Pb), and carotid pulse pressure (PP) on admission in patients hospitalized due to AHFS.A total of 120 patients (72 ± 14 years, 83.3% men) hospitalized due to AHFS (55.8% with systolic heart failure) were enrolled. Measures of cAI, cAP, Pb, carotid PP, and carotid–femoral pulse wave velocity (cf-PWV) by tonometry and thoracic fluid content (TFC) by impedance cardiography were obtained within 24 h of admission. N-terminal pro brain natriuretic peptide (NT-proBNP) levels were determined before discharge. Patients were followed up for a median of 601 days, accruing 66 adverse events including re-hospitalization for heart failure, non-fatal myocardial infarction, non-fatal stroke, and death. In univariate Cox analysis, all measures significantly predicted post-discharge events (all P < 0.05). In multivariate analysis, cAP [hazard ratio per SD and 95% confidence interval: 1.32 (1.051–1.67), P = 0.017], Pb [1.44 (1.13–1.84), P = 0.004] and carotid PP [1.35 (1.05–1.73), P = 0.019], but not cAI, TFC, or cf-PWV, significantly independently predicted events with adjustments for age, estimated glomerular filtration rate, haemoglobin, and NT-proBNP.On-admission measures of wave reflection magnitude, including cAP, Pb, and carotid PP, may be useful for predicting long-term outcomes in AHFS patients. The results support a major role for wave reflection in the pathogenesis of AHFS.