Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.
Faculdade de Medicina da Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS - Brasil.
Arq Bras Cardiol. 2024 Jun 17;121(5):e20230745. doi: 10.36660/abc.20230745. eCollection 2024.
Residual venous congestion is a major contributor to readmission of patients with heart failure, and the venous excess ultrasound (VExUS) score is a potentially useful tool to evaluate systemic congestion.
To investigate the association between VExUS score before hospital discharge among patients with heart failure and the risk of readmission due to acute decompensated heart failure (ADHF) within 90 days after discharge.
This prospective cohort study enrolled adults with signs and symptoms of ADHF, left ventricular ejection fraction of 40% or below (heart failure with reduced ejection fraction), New York Heart Association functional class II to IV symptoms, and clinical evidence of venous congestion necessitating intravenous diuretics. Just prior to discharge, we conducted VExUS score evaluation. The primary outcome was a composite endpoint of readmission or emergency visits due to ADHF within 90 days following hospital discharge. Statistical significance was set at p < 0.05.
The cohort comprised 49 individuals, 11 (22.4%) of whom experienced the primary outcome. At discharge, 34.7% of participants had VExUS score 2 or 3. Patients with VExUS 2 and 3 had a higher proportion of the primary outcome when compared with patients with VExUS of 0 (35.3% versus 9%, p = 0.044).
A significant proportion of patients with heart failure with reduced ejection fraction admitted for ADHF presented clinical and ultrasound signs of residual congestion at discharge. Patients with VExUS score of 2 or 3 at the time of hospital discharge were found to be at higher risk of readmissions or emergency visits due to ADHF after 90 days.
静脉淤血残留是心力衰竭患者再入院的主要原因，静脉淤血超声（VExUS）评分是评估全身淤血的一种潜在有用的工具。
研究心力衰竭患者出院前 VExUS 评分与出院后 90 天内因急性失代偿性心力衰竭（ADHF）再入院风险之间的关系。
这项前瞻性队列研究纳入了有 ADHF 症状和体征、左心室射血分数 40%或以下（射血分数降低的心力衰竭）、纽约心脏协会功能分级 II 至 IV 级症状和临床静脉淤血证据需要静脉利尿剂的成年人。在出院前，我们进行了 VExUS 评分评估。主要结局是出院后 90 天内因 ADHF 再入院或急诊就诊的复合终点。统计显著性设为 p < 0.05。
该队列包括 49 人，其中 11 人（22.4%）发生了主要结局。出院时，34.7%的参与者 VExUS 评分为 2 或 3。与 VExUS 评分为 0 的患者相比，VExUS 评分为 2 和 3 的患者发生主要结局的比例更高（35.3%比 9%，p = 0.044）。
因 ADHF 入院的射血分数降低的心力衰竭患者中，相当一部分患者在出院时存在临床和超声残留淤血的迹象。出院时 VExUS 评分 2 或 3 的患者在出院后 90 天内因 ADHF 再入院或急诊就诊的风险更高。
