I just tried it on a less than optimal PC and on HDD that it warns against using just to see how it is and it did better than I thought. All medium settings and down to balanced FSR2 which looks alright still on 1440p, I eventually locked it to 30fps with RTSS and that way it seemed perfectly stable (lots of headroom, plenty areas where it went to 50 or more fps but plenty where it hovered at 30-40 and I guess going by what folks say other scenes are much more demanding so we'll see if it can actually drop below 30, that wouldn't be great).
The most demanding part so far is the main menu for some reason, lol, almost single digit fps every time I go in the settings.
The slow HDD loading seems to cause some pop in, I noticed one of the dead bodies pop in after I turned a corner and when I first open the door to a room with glass windows viewing across the rail tracks, that's just black void at the windows and then the view comes on as if someone turns on the lights outside (but it was a nice way to make pop in less obvious, hopefully later areas keep doing such things). I *think* there's no actual loading stutter cos they've decoupled that aspect from how the game runs. Correct me if I'm wrong but just wandering about with the 30fps lock I didn't notice any jumps and stutters or hitches (but that's after all the events there had all played out on my first run so I guess I need to test that). So I guess I might as well play this since the original is technically locked to 30fps anyway. As long as performance doesn't go to shit later.
It somehow seems quite janky like the original too, without the excuse of being the first/old. The melee bashing and stomping and how the various objects interact with that and just fly off or whatever, all the physics basically. Also why on earth did they keep the stomping system as it was? It's fine for enemies I guess (it could be on the same button as the melee attack but be context sensitive if the enemy is low), but why have Isaac still be a psycho stomping and tearing apart every dead body because it's a potential loot pinatal? Just let folks get the items with just interacting with the body.
Same for the boxes, just E to fake open them (even without an animation for each and every one you come across since that could get old) rather than bashing them would be fine.
The settings also seem pretty lean, nothing related to textures, shadow cache, whatever stuff a comparable game like RE2 and its RE engine offer to optimize to your particular set up and its available RAM/VRAM and asset streaming potential.
It sure doesn't look better than RE2 which gets to a viable 60fps norm on the same system (but with some loading stutters as you go about which can't really be eliminated on it) with some tweaks but generally much higher settings.
At least it boots quite fast right in the last save after booting it again, that was neat though it also had a lot of texture pop in similar to UE games, that is understandable in that case given this PC.
/2c
Edit: ok definitely get some stutters when stuff goes down but nothing too bad, same as most demanding games on an aging PC that doesn't quite cut it for them. Also FSR quality resets to Quality every time, gotta get it to lower after boot (changing it in the settings file doesn't stick either).