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. 2024 Oct 21;13(20):6272.
doi: 10.3390/jcm13206272.

Venous Excess Ultrasound Score Is Associated with Worsening Renal Function and Reduced Natriuretic Response in Patients with Acute Heart Failure

Sofya Sovetova  1   2 , Kristina Charaya  2 , Tamerlan Erdniev  2 , Dmitry Shchekochikhin  2   3 , Alexandra Bogdanova  2 , Sergey Panov  2 , Natalya Plaksina  2 , Elmira Mutalieva  2 , Natalia Ananicheva  1 , Viktor Fomin  2 , Denis Andreev  2
Affiliations

Venous Excess Ultrasound Score Is Associated with Worsening Renal Function and Reduced Natriuretic Response in Patients with Acute Heart Failure

Sofya Sovetova et al. J Clin Med. .

Abstract

Background: The venous excess ultrasound score (VExUS) is used to objectify systemic venous congestion. The aim of the paper was to determine the association between VExUS grades and worsening renal function (WRF), reduced natriuretic response, diuretics resistance, and mortality in patients with acute heart failure (AHF). Methods: One hundred patients were included, and Doppler ultrasound of hepatic, portal, and renal veins was performed. Severity of congestion was graded using the VExUS score (grade 0, 1, 2, or 3). Sodium concentration in a spot urine sample was assessed in 2 h after the first loop diuretic administration and was adjusted for the prescribed dose of furosemide (31 mmol/40 mg). Diuretics resistance was defined as the need to double the starting dose of intravenous furosemide in 6 h. Results: Patients with VExUS grade 3 showed a higher incidence of WRF (OR: 11.17; 95% CI: 3.86-32.29; p < 0.001) and a decreased natriuretic response: a spot urine sodium content of <50 mmol/L (OR: 21.53; 95% CI: 5.32-87.06; p < 0.001) and an adjusted spot urine sodium content of <31 mmol/40 mg (OR: 9.05; 95% CI: 3.15-25.96; p < 0.001). The risk of diuretic resistance (OR: 15.31; 95% CI: 5.05-46.43; p < 0.001), as well as the need for inotropic and/or vasopressor support (OR: 11.82; 95% CI: 3.59-38.92; p < 0.001), was higher in patients with severe congestion. The hospital mortality rate increased in patients with VExUS grade 3 compared to in patients with other grades (OR: 26.4; 95% CI: 5.29-131.55; p < 0.001). Conclusions: Patients with AHF and VExUS grade 3 showed a higher risk of developing WRF, a decreased diuretic and natriuretic response, a need for inotropic and/or vasopressor support, and a poor prognosis during their hospital stay.

Keywords: Doppler ultrasound; VExUS; acute heart failure; decongestion; diuretics; hepatic vein; intra-renal vein; natriuresis; portal vein; sodium; venous excess ultrasonography.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study protocol. VExUS—venous excess ultrasound score; WRF—worsering renal function.
Figure 2
Figure 2
The VExUS grade and worsering renal function. CI—confidence interval; OR—odds ratio; VExUS—venous excess ultrasound score; WRF—worsering renal function.
Figure 3
Figure 3
Spot urinary sodium concentration in 2 h after the first standard intravenous loop diuretic administration across different VExUS grades. The black horizontal line in the middle of the boxes is the median sodium concentration. A symbol (○) indicates outliers. A symbol (*) indicates extreme outliers. VExUS—venous excess ultrasound score.
Figure 4
Figure 4
Risks of diuretic resistance in patients with different VExUS grades. CI—confidence interval; OR—odds ratio; VExUS—venous excess ultrasound score.
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