Early improvement in the vti–vexus index identifies survival in acute decompensated heart failure

Background The VTI–VeXUS index integrates arterial flow (LVOT-VTI) and venous congestion (VeXUS score) into a single haemodynamic metric. While proof-of-concept data in septic shock suggest potential prognostic value, its ability to reflect treatment response in acute decompensated heart failure (ADHF) is unknown. Purpose To evaluate whether early dynamic changes in the VTI–VeXUS index are associated with in-hospital mortality in patients admitted with ADHF. Methods We analysed a prospective cohort of patients hospitalized for ADHF who underwent echocardiographic assessment of LVOT-VTI and VeXUS at admission and after 72 hours. The VTI–VeXUS index was calculated as VTI/(VeXUS+1). Dynamic change (ΔVTI–VeXUS) was analysed as a continuous variable and in multivariable logistic regression adjusting for clinical severity markers. The primary outcome was in-hospital mortality. Results Among 114 patients, survivors demonstrated greater improvement in VTI–VeXUS over 72 hours compared with non-survivors. Each unit increase in ΔVTI–VeXUS was associated with a 25% reduction in the odds of in-hospital mortality (OR 0.75, 95% CI 0.60–0.90, p<0.05) and remained independently predictive after adjustment (OR 0.79, 95% CI 0.63–0.94, p=0.01). ROC analysis showed moderate discrimination (AUC≈0.71) for in-hospital mortality, and predicted mortality declined progressively with increasing ΔVTI–VeXUS. Conclusions In ADHF, early trajectory of the VTI–VExUS index identifies effective haemodynamic response and independently predicts survival. Serial assessment may provide an objective bedside target to guide decongestion therapy.