Prognostic implications of venous excess ultrasound score in acute heart failure

Background Venous Excess Ultrasound score (VExUS) is gaining attention as a novel ultrasonographic tool that allows accurate quantification of systemic congestion. Purpose This study sought to explore the prognostic value of VExUS assessed before discharge in hospitalized patients with acute heart failure (HF). Methods Consecutive patients admitted for acute HF were prospectively enrolled. Inferior vena cava diameter, hepatic vein, portal vein and renal vein Doppler waveforms were assessed within 24 hours before discharge and patients were stratified based on VExUS score from 0 to 3, with higher values indicating worse congestion. Patients were followed up for the primary endpoint of all-cause mortality and HF rehospitalization. Results Out of 428 patients (73.2±12.1 years old, 58.9% male), 228 (53.3%) were stratified as VExUS 0, 64 (15.0%) as VExUS 1, 59 (13.8%) as VExUS 2, and 77 (18.0%) as VExUS 3. During a median follow-up of 9 months (interquartile range: 4.0-11.7 months), 161 (37.6%) patients reached the primary endpoint. There was a stepwise increase in the percentage of cumulative events with higher VExUS values, with VExUS 3 patients demonstrating the highest risk (VExUS 0: 25.4%, VExUS 1: 29.7%, VExUS 2: 52.5%, VExUS 3: 68.8%, Log-rank p <0.001) (Picture 1). VExUS 3 was independently associated with the primary endpoint (adjusted HR: 1.77 [95% CI, 1.06 – 9.94]; p =0.029) and provided incremental prognostic value over clinical, biochemical, and echocardiographic variables (Picture 2). Conclusion VExUS appears to be a reliable tool for risk stratification in hospitalized acute HF patients. The presence of severe, residual congestion at discharge, as indicated by VExUS 3, has incremental additive value over and above clinical, biochemical and echocardiographic biomarkers for predicting worse outcome at mid-term follow-up.Picture 1: Event-free survival Picture 2: Incremental prognostic value