Venous excess ultrasound (VExUS) score as a predictive tool of heart failure readmission in acute heart failure: a prospective study
F Ben Ghorbel, S Antit, L ZakhamaAbstract
Introduction
Acute heart failure (AHF) is characterised by a high burden of early and recurrent heart failure (HF) rehospitalisations, reflecting a progressive disease trajectory and contributing substantially to adverse outcomes. Improved prognostic stratification is essential to identify patients at high risk of recurrence. Congestion is a central determinant of rehospitalisation in AHF. While pulmonary congestion assessed by lung ultrasound is well established, the prognostic role of systemic venous congestion remains less clearly defined. The Venous Excess Ultrasound (VExUS) score provides a non-invasive doppler assessment of venous congestion, but its value for predicting HF rehospitalisation has not been fully established.
Purpose
This study aimed to evaluate the association between VExUS score and HF rehospitalisation in patients hospitalised for AHF. Secondary objectives also aimed to characterise patients with moderate-to-severe venous congestion defined by a high VExUS score.
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 and followed for 6 months, 44 (50.6%) experienced at least one HF rehospitalisation. At 3 months, rehospitalisation occurred in 50.0% of patients with high venous congestion (VExUS ≥2) versus 13.8% in those with VExUS 0–1 (p = 0.006), and remained higher at 6 months (36.2% vs. 13.8%; p = 0.048). In multivariable analysis, severe venous congestion (VExUS grade 3) was independently associated with HF rehospitalisation (OR 8.31, 95% CI 1.45–16.48; p < 0.001). The VExUS score showed good discrimination for HF rehospitalisation (AUC 0.76). Patients with high VExUS had more advanced coronary disease, greater anaemia, worse renal and hepatic function, lower cardiac output, more impaired right ventricular function, higher pulmonary artery systolic pressure, more severe tricuspid regurgitation, and required higher doses of loop diuretics, catecholamines, and renal replacement therapy.
Conclusion
Severe venous congestion, defined as VExUS grade3, independently predicted HF rehospitalisation, supporting VExUS as a simple bedside tool for risk stratification in AHF.