Playthrough Roadmap
There are 4 ending screens:
Beat the game without all items in over 4 hours
Beat the game with all items in over 4 hours
Beat the game with all items in under 4 hours
Beat the game in under 2 hours
There is also an achievement for beating the game without collecting any heart containers.
Playthrough 1
Do NOT collect any heart containers
Finish the game in over 4 hours
Afterward:
Reload your last save
Collect all remaining items
Defeat the final boss again
Playthrough 2
Beat the game in under 2 hours
Skip optional items to save time
Afterward:
Reload your speedrun save
Collect all missed items
Defeat the final boss again before the in-game timer reaches 4 hours
Guide
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