ΔVExPLUs: prognostic value of integrating serial changes in VExUS score and lung ultrasound in acute decompensated heart failure

Abstract Aims To investigate whether early combined changes in venous excess ultrasound (VExUS) and lung ultrasound (LUS) were associated with outcomes in acute decompensated heart failure (ADHF). Methods and results We prospectively enrolled 104 patients with ADHF mean age 64.3 ± 13.5 years, 69.2% male, median left ventricle ejection fraction 24.5% (18.0, 32.0). VExUS score and LUS were performed within 24 h of admission and after 72 h. Changes in congestion were integrated into a single metric (ΔVExPLUs = 2 × ΔVExUS + ΔLUS), with ΔVExUS multiplied by two to balance its narrower scoring range. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day all-cause mortality and a composite of 30-day all-cause mortality, heart transplantation and left ventricular assist device implantation. Patients with greater ΔVExPLUs improvement had lower rates of in-hospital mortality (3% vs. 46%; P 0.001), 30-day mortality (12% vs. 50%; P = 0.007), and the composite outcome (19% vs. 64%; P = 0.002). In multivariable analysis, ΔVExPLUs ≥ 1 was independently associated with in-hospital mortality odds ratio (OR): 0.65; 95% confidence interval (CI): 0.51, 0.83; P 0.001, 30-day mortality (OR: 0.78; 95% CI: 0.65, 0.94; P = 0.009), and the composite outcome (OR: 0.76; 95% CI: 0.64, 0.92; P = 0.004). For in-hospital mortality, ΔVExPLUs achieved the highest area under the curve (AUC) (0.76), with a sensitivity of 95.6% and a negative predictive value of 97.0%, compared with ΔVExUS (AUC: 0.70) and ΔLUS (AUC: 0.65). Conclusion Serial integration of systemic and pulmonary ultrasound parameters through ΔVExPLUs is independently associated with short-term outcomes in ADHF and may improve early risk stratification.