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. 2024 Jul 10;4(5):oeae050.
doi: 10.1093/ehjopen/oeae050. eCollection 2024 Sep.

Assessment of venous congestion with venous excess ultrasound score in the prognosis of acute heart failure in the emergency department: a prospective study

Irene Landi  1 , Ludovica Guerritore  2 , Andrea Iannaccone  3 , Andrea Ricotti  4 , Philippe Rola  5 , Marco Garrone  2
Affiliations

Assessment of venous congestion with venous excess ultrasound score in the prognosis of acute heart failure in the emergency department: a prospective study

Irene Landi et al. Eur Heart J Open. .

Abstract

Aims: In acute decompensated heart failure (HF), systemic venous congestion contributes to patients' symptoms and hospital admissions. The purpose of our study is to determine if venous congestion, examined using the venous excess ultrasound (VExUS) score, predicts HF-related hospitalization and mortality in patients admitted to the emergency department (ED) with acute decompensated HF.

Methods and results: Fifty patients admitted for acute HF in ED underwent ultrasound (US) assessment according to the VExUS score within the first 24 and 72 h. All patients were followed up with a telephone call at 30 and 60 days after hospital discharge. On admission, 56% had a VExUS score of 3. After 72 h, 32% had no more signs of congestion at the Doppler VExUS examination (inferior vena cava < 2 cm, VExUS score of 0); a similar percentage still exhibited a VExUS score of 3 despite therapy. Eighty per cent of patients were hospitalized after admission to the ED, while six (15%) died in-hospital; all exhibited a first-assessment VExUS score of 3. No patient with a VExUS score < 3 died during the study. During short-term follow-up, 18 patients were readmitted to the ED for acute decompensated HF. Ninety-four per cent of the readmitted patients had a VExUS score of 3 at the Doppler assessment at the first ED admission.

Conclusion: Severe venous congestion, defined as a VExUS score of 3 at the initial assessment of patients with acute decompensated HF, predicts inpatient mortality, HF-related death, and early readmission.

Keywords: Congestive heart failure; Point-of-care ultrasound; VExUS score; Venous congestion.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
The Kaplan–Meier curve for the probability of readmission comparing mild-to-moderate congestion (venous excess ultrasound score of 1–2) and severe venous congestion (venous excess ultrasound score of 3).
Figure 2
Figure 2
The Kaplan–Meier curve for the probability of survival comparing mild-to-moderate congestion (venous excess ultrasound score of 1–2) and severe venous congestion (venous excess ultrasound score of 3).
Figure 3
Figure 3
The Kaplan–Meier curve for the probability of readmission comparing mild-to-moderate congestion (venous excess ultrasound score of 1–2) and severe venous congestion (venous excess ultrasound score of 3) adjusted for creatinine values. VExUS 1–2 norm, patients with venous excess ultrasound score of 1–2 with normal creatinine values (≤1.2 mg/dL); VExUS 1–2 alt, patients with venous excess ultrasound score of 1–2 with altered creatinine values (>1.2 mg/dL); VExUS 3 norm, patients with venous excess ultrasound score of 3 with normal creatinine values (≤1.2 mg/dL); VExUS 3 alt, patients with venous excess ultrasound score of 3 with altered creatinine values (>1.2 mg/dL).
See this image and copyright information in PMC

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