Long-Term Prognostic Implications of Venous Excess Ultrasound Score in Acute Heart Failure

Venous excess ultrasound (VExUS) score is gaining attention as a novel ultrasonographic tool that allows accurate quantification of systemic congestion. This study sought to explore the prognostic value of VExUS score assessed at discharge in hospitalized patients with acute heart failure (HF).

Consecutive patients admitted for acute HF were prospectively enrolled. Inferior vena cava diameter and 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 end point of all-cause mortality and HF rehospitalization.

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 12 ± 2.6 months, 161 (37.6%) patients reached the primary end point. 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 < .001). This pattern was consistent for HF with reduced (<50%) and preserved (≥50%) ejection fraction phenotype. The VExUS score was independently associated with the primary end point (adjusted hazard ratio = 1.33 [95% CI, 1.05-1.68]; P = .017) and provided incremental prognostic value over clinical, biochemical, and echocardiographic variables.

The VExUS score at discharge appears to be a reliable tool for risk stratification in hospitalized acute HF patients for predicting worse outcome at long-term follow-up.