Modified Venous Excess Ultrasound: A Dynamic Tool to Predict Mortality in Acute Decompensated Heart Failure

Area of Science:

• Cardiology
• Critical Care Medicine
• Diagnostic Imaging

Background:

• Assessing systemic venous congestion in acute decompensated heart failure (ADHF) is clinically challenging.
• The Venous Excess Ultrasound (VExUS) score is a noninvasive tool for evaluating venous congestion.
• The prognostic significance of VExUS, particularly dynamic changes, in ADHF requires further investigation.

Purpose of the Study:

• To evaluate the prognostic role of repeated VExUS score measurements in predicting in-hospital mortality in ADHF patients.
• To determine if changes in the VExUS score over the initial 72 hours of intensive care unit admission correlate with clinical markers of decongestion and patient outcomes.

Main Methods:

• A prospective cohort study involving 104 ADHF patients with LVEF < 50% admitted to a cardiovascular ICU.
• Modified VExUS (mVExUS) scores were assessed at baseline (within 24 hours) and at 72 hours.
• ΔVExUS (change in mVExUS score) was calculated, with improvement defined as ΔVExUS ≥ 1. Primary outcome was in-hospital mortality.

Main Results:

• Patients with mVExUS improvement (ΔVExUS ≥ 1) showed significantly better urine output, weight loss, and reduction in serum creatinine and congestion scores.
• In-hospital mortality was substantially lower in the mVExUS improvement group (11.1% vs. 36.4%, P = 0.007).
• ΔVExUS ≥ 1 was independently associated with reduced in-hospital mortality (aOR 0.31; P = 0.004) and identified as a key predictor via LASSO regression.

Conclusions:

• A reduction of ≥1 point in the mVExUS score within 72 hours (ΔVExUS ≥ 1) is an independent predictor of lower in-hospital mortality in ADHF.
• This dynamic mVExUS assessment is linked to favorable clinical and laboratory markers of decongestion.
• Repeated mVExUS measurements offer a practical, bedside tool for enhanced risk stratification in ADHF patients.