VEXUS protocol as a prognostic tool in acute heart failure: A systematic review and Bayesian meta-analysis

Systemic venous congestion is a key determinant of prognosis in acute heart failure (AHF). The Venous Excess Ultrasound (VExUS) score has emerged as a bedside tool to assess congestion, but its prognostic value in AHF remains uncertain. We aimed to evaluate the association between VExUS and in-hospital mortality in patients hospitalized with AHF.

PubMed, Embase, and the Cochrane Library were searched for studies assessing the prognostic value of VExUS in AHF. Patients with VExUS ≤1 were compared to those with VExUS ≥2 for the primary endpoint of in-hospital mortality. A Bayesian random-effects meta-analysis estimated marginal posterior distributions for overall effect and heterogeneity.

Five studies including 565 patients were analyzed, most with VExUS grade 3 and reduced ejection fraction. In-hospital mortality occurred in 1.9% of patients with VExUS ≤1 (4/210) and in 14.1% with VExUS ≥2 (50/355), corresponding to a mean odds ratio of 0.175 (95% CrI: 0.061-0.497). The posterior probability of an association (OR<1) was 99.91%, and of a clinically relevant effect (OR<0.8) was 99.93%. The predictive distribution showed a 95% probability that the true odds ratio in a future study would range from 0.045 to 0.681. Sensitivity analyses using weakly informative and vague priors yielded consistent results.

Lower VExUS grades were associated with reduced in-hospital mortality, supporting the role of VExUS as a bedside tool for prognostic risk stratification in acute heart failure.