First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
424 General Military Hospital of Thessaloniki, Thessaloniki, Greece.
J Am Soc Echocardiogr. 2024 Oct;37(10):923-933. doi: 10.1016/j.echo.2024.05.011. Epub 2024 May 19.
This study sought to explore the prevalence and clinical utility of different patterns of multiorgan venous congestion as assessed by the venous excess ultrasound (VExUS) score in hospitalized patients with acute heart failure (HF).
Consecutive patients admitted for acute HF were prospectively enrolled. Inferior vena cava diameter, hepatic vein, portal vein, and renal vein Doppler waveforms were assessed at admission, and patients were stratified based on VExUS score from 0 to 3, with higher values indicating worse congestion. The clinical score Get with the Guidelines (GWTG)-HF for predicting in-hospital mortality in HF was evaluated. In-hospital mortality was recorded.
Two hundred ninety patients admitted with acute HF were included, and 114 (39%) of them were classified as VExUS score 3, which was the most prevalent group. Patients with VExUS score 3 suffered more frequently from chronic atrial fibrillation, chronic kidney disease, and anemia. Parameters independently associated with VExUS score 3 were higher mean E/e' ratio, larger right ventricular size, severe tricuspid regurgitation, and impaired right atrial function. A VExUS score of 3 was associated with in-hospital mortality (odds ratio, 8.03; 95% CI [2.25-28.61], P = .001). The addition of VExUS score on top of the GWTG-HF score improved the predictability of the model (Δx = +8.44, P = .03) for in-hospital mortality, whereas other indices of venous congestion (right atrial function, inferior vena cava size) did not.
Patients admitted with acute HF commonly had severe venous congestion based on the VExUS score. The VExUS score improved the prediction of in-hospital mortality compared with other indices of venous congestion.
本研究旨在探讨通过静脉过度超声（VExUS）评分评估的住院急性心力衰竭（HF）患者多器官静脉充血不同模式的流行程度和临床实用性。
连续纳入因急性 HF 入院的患者。入院时评估下腔静脉直径、肝静脉、门静脉和肾静脉多普勒波型，并根据 VExUS 评分（0-3 分）将患者分层，得分越高表明充血越严重。评估用于预测 HF 住院死亡率的指南获得（GWTG）-HF 临床评分。记录住院死亡率。
共纳入 290 例因急性 HF 入院的患者，其中 114 例（39%）被归类为 VExUS 评分 3 分，是最常见的组。VExUS 评分 3 分的患者更频繁地患有慢性心房颤动、慢性肾脏病和贫血。与 VExUS 评分 3 分独立相关的参数是更高的平均 E/e' 比值、更大的右心室大小、严重的三尖瓣反流和右心房功能受损。VExUS 评分 3 分与住院死亡率相关（优势比，8.03；95%CI [2.25-28.61]，P =.001）。在 GWTG-HF 评分的基础上增加 VExUS 评分可提高模型对住院死亡率的预测能力（Δx = +8.44，P =.03），而其他静脉充血指标（右心房功能、下腔静脉大小）则不然。
因急性 HF 入院的患者通常根据 VExUS 评分存在严重的静脉充血。与其他静脉充血指标相比，VExUS 评分可提高住院死亡率的预测能力。
