Venous excess ultrasound (VExUS) score as a predictive tool of all-cause mortality in acute heart failure: a prospective study
F Ben Ghorbel, S Antit, L ZakhamaAbstract
Introduction
Heart failure (HF) remains a major global public health problem, associated with a substantial economic burden and high mortality. In acute heart failure (AHF), several clinical, biological and echocardiographic factors have been linked to poor prognosis. Beyond pulmonary congestion, we focused on systemic venous congestion as an additional and underexplored determinant of outcomes, assessed using the Venous Excess Ultrasound (VExUS) score.
Purpose
This study aimed to evaluate the association between the VExUS score and all-cause mortality in patients hospitalised for AHF.
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. 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, 14 patients (16.1%) died during follow-up, including seven deaths (8.0%) during the index hospitalisation, two at 3 months (2.3%), and five at 6 months (5.8%). Among deceased patients, 85.7% presented with severe venous congestion (VExUS grade 3), and all in-hospital deaths occurred in patients with VExUS grade 3. In multivariable analysis, VExUS grade 3 was independently associated with all-cause mortality (OR 4.30, 95% CI 1.50–18.10; p=0.042). The VExUS score demonstrated good discriminative performance for mortality prediction (AUC 0.73), with high sensitivity (86.8%) and excellent negative predictive value (95.2%). Renal venous doppler assessment also showed good predictive performance (AUC 0.76) with an excellent negative predictive value (94.3%). using a monophasic renal venous flow pattern as the prognostic cut-off.
Conclusion
Severe venous congestion assessed by a VExUS grade 3 was independently associated with all-cause mortality. As a simple and reproducible bedside tool, the VExUS score enables risk stratification and prediction of clinically relevant outcomes in acute heart failure.