PATIENTS hospitalised with acute heart failure (HF) often exhibit severe venous congestion, and the venous excess ultrasound (VExUS) score offers a more refined prediction of in-hospital mortality compared to traditional methods of congestion assessment.
One of the main challenges in managing patients with acute HF is accurately assessing systemic congestion to guide treatment decisions. Traditionally, congestion has been evaluated through physical signs or inferior vena cava diameter, both of which have limitations such as delayed presentation of symptoms and poor correlation with right atrial pressure. The VExUS score, a novel ultrasonography-based tool, assesses venous congestion across multiple organs, providing a more comprehensive picture of the patient’s condition. This study aimed to investigate the prevalence and clinical utility of VExUS in predicting outcomes for patients hospitalized with acute HF.
The study prospectively enrolled 290 patients admitted for acute HF. Ultrasonography was used to evaluate IVC diameter and Doppler waveforms from the hepatic, portal, and renal veins. Patients were stratified into groups based on their VExUS scores, ranging from 0 to 3, with a higher score indicating more severe congestion. The Get with the Guidelines (GWTG)-HF score, a clinical tool for predicting in-hospital mortality, was also applied, and the results were compared with VExUS scoring. Among the patients, 114 (39%) were classified as having a VExUS score of 3, the most severe congestion group. These patients had a higher prevalence of comorbidities such as chronic atrial fibrillation, chronic kidney disease, and anaemia. A VExUS score of 3 was also associated with worse cardiac function parameters and an eightfold increase in the odds of in-hospital mortality (odds ratio: 8.03; 95% CI: 2.25-28.61; p= 001). The addition of VExUS scoring significantly improved mortality prediction beyond the GWTG-HF score alone.
In conclusion, the VExUS score is a valuable tool for assessing venous congestion in patients with acute HF and provides enhanced predictive accuracy for in-hospital mortality. Future research should focus on integrating VExUS into routine clinical practice and exploring its potential to guide therapeutic decisions in heart failure management.
Katrina Thornber, EMJ
Reference
Anastasiou V et al. Multiorgan congestion assessment by venous excess ultrasound score in acute heart failure. J Am Soc Echocardiogr. 2024;37(10):923-33.
