Venous Excess Ultrasound (VExUS) score and short-term outcomes in ambulatory patients with heart failure with reduced ejection fraction: an exploratory study.

BACKGROUND

Venous congestion significantly contributes to morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). The Venous Excess Ultrasound (VExUS) score, a multi-parameter sonographic assessment of systemic venous congestion, has shown prognostic utility in hospitalized HFrEF. However, its role in risk-stratifying ambulatory HFrEF patients remains unclear. This prospective exploratory study investigated the prognostic value of elevated VExUS scores in ambulatory HFrEF patients.

RESULTS

Of 109 enrolled patients, 23 (21%) had a high VExUS score (≥ 2). Patients with high VExUS scores had significantly higher rates of the primary composite endpoint of all-cause mortality or HF hospitalization within 90 days (87% vs. 19.8%, p < 0.001), worsening renal function (47.8% vs. 17.3%, p < 0.001), and unplanned visits (82.6% vs. 14.8%, p < 0.001). While dilated IVC had higher sensitivity for the primary outcome, VExUS demonstrated greater specificity, especially in patients with moderate to severe tricuspid regurgitation (TR).

CONCLUSIONS

An elevated VExUS score was associated with adverse short-term outcomes in this exploratory analysis. VExUS score may provide a more specific assessment of congestion than IVC diameter alone, particularly in the presence of significant TR, potentially improving risk stratification in this population.