Venous excess ultrasound score and clinical outcomes in acute heart failure
F Ben Ghorbel, S Antit, B Ben Kaab, K Bahri, E Boussabeh, L ZakhamaAbstract
Background
Acute heart failure (AHF) is associated with a high burden of recurrent hospitalisations and mortality, highlighting the need for improved prognostic stratification. Beyond traditional clinical and echocardiographic markers, systemic venous congestion may represent a key but under-recognised determinant of adverse outcomes. The Venous Excess Ultrasound (VExUS) score provides a bedside doppler-based assessment of multi-organ venous congestion, yet its prognostic value for clinically relevant outcomes in AHF remains incompletely defined.
Purpose
This study aimed to evaluate the association between VExUS and the composite endpoint of heart failure (HF) rehospitalisation or all-cause mortality.
Methods
This monocentric, prospective study with a cross-sectional assessment and longitudinal follow-up was conducted between February and December 2024. Consecutive adult patients (≥18 years) admitted to the intensive care unit for acute de novo HF or acute decompensation of chronic HF were considered for inclusion. Patients with chronic haemodialysis, severe baseline renal impairment (creatinine clearance <30 mL/min), liver cirrhosis, portal hypertension, or inferior vena cava thrombosis were not included. Clinical, biological, and echocardiographic data were collected during the index hospitalisation, with follow-up at 3, and 6 months after discharge to assess the composite endpoint defined as the first occurrence of HF readmission or all-cause mortality. The VExUS score was systematically assessed at 24 hours after admission, at discharge, and at three-month follow-up.
Results
Among 87 patients hospitalised for AHF, the median age was 66 [58–74] years and 46% had ischaemic heart disease. During follow-up, 44 patients (50.6%) experienced at least one HF rehospitalisation, 14 patients (16.1%) died, including seven deaths (8.0%) during the index hospitalisation and 60.9% experienced the composite endpoint. Severe venous congestion defined as VExUS grade 3 was present in 71.7% of those experiencing the composite outcome. In multivariable analysis, VExUS grade 3 was independently associated with the composite endpoint (OR 7.50, 95% CI 2.60–11.64; p< 0.001), as were monophasic renal venous flow (RVF) (OR 8.80, 95% CI 2.81–17.55, p<0.001) and hepatic vein S-wave inversion (OR 6.69 95% CI 2.57-14.42, p<0.001). No significant association was observed with portal vein pulsatility. VExUS grade 3 demonstrated good discrimination for the composite endpoint (AUC 0.78), similar to monophasic RVF and hepatic vein S-wave inversion (AUC 0.72 for both). A combined model integrating VExUS grade 3, monophasic RVF and hepatic vein S-wave inversion further improved prognostic performance (AUC 0.81), with high specificity (88.2%) and positive predictive value (87.5%).
Conclusion
In patients with AHF, the VExUS score and associated venous doppler abnormalities are strongly associated with HF rehospitalisation and all-cause mortality.