Composite Ultrasound Score Integrating VExUS Grading and Right Ventricular Function for Predicting 90-Day Heart...

Systemic venous congestion and right ventricular (RV) dysfunction are important determinants of adverse outcomes in heart failure (HF). This study evaluated the prognostic value of a Composite Ultrasound Score integrating Venous Excess Ultrasound (VExUS) grading and multiparametric RV systolic function for predicting 90-day HF rehospitalization.

This single-center retrospective cohort study included 712 patients hospitalized for HF who underwent pre-discharge echocardiographic assessment. The Composite Ultrasound Score ranged from 0 to 3 and combined VExUS-derived venous congestion with RV systolic dysfunction defined by TAPSE, RV S', and RV fractional area change. The primary endpoint was 90-day HF rehospitalization. Predictive performance was assessed using Cox regression, Harrell's C-index, time-dependent receiver operating characteristic analysis, and decision curve analysis.

During follow-up, 154 patients (21.6%) were rehospitalized. The Composite Ultrasound Score showed higher discrimination (C-index: 0.79; 95% CI: 0.75-0.83) than VExUS grading alone (0.74; P = 0.012), NT-proBNP (0.71; P < 0.001), or individual RV parameters. A score ≥2 identified a high-risk group with a 90-day event rate of 50.0% versus 8.3% in the low-risk group (log-rank P < 0.001). A high score remained independently associated with rehospitalization (adjusted HR: 2.85; 95% CI: 1.95-4.16; P < 0.001). The association was stronger in patients with chronic kidney disease (P for interaction = 0.038). Decision curve analysis suggested greater net benefit than single-parameter strategies.

The Composite Ultrasound Score was independently associated with 90-day HF rehospitalization and showed moderate incremental prognostic value in this single-center retrospective cohort. It may serve as a promising adjunctive tool for pre-discharge risk stratification, particularly in patients with cardiorenal vulnerability. Prospective multicenter validation is required before routine clinical implementation.