Hassan Ahmed, Khalil Ahmed A, Mostafa Amir, Yehia Hesham
Cardiology Department, cairo university, Cairo, Egypt.
Egypt Heart J. 2025 Jun 13;77(1):60. doi: 10.1186/s43044-025-00648-w.
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.
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).
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.
静脉淤血在射血分数降低的心力衰竭(HFrEF)患者的发病和死亡中起重要作用。静脉过度超声(VExUS)评分是一种对体循环静脉淤血进行多参数超声评估的方法,已显示出对住院HFrEF患者的预后价值。然而,其在非卧床HFrEF患者风险分层中的作用仍不明确。这项前瞻性探索性研究调查了非卧床HFrEF患者中VExUS评分升高的预后价值。
在109名入组患者中,23名(21%)VExUS评分较高(≥2)。VExUS评分高的患者在90天内全因死亡或心力衰竭住院的主要复合终点发生率显著更高(87%对19.8%,p<0.001),肾功能恶化发生率(47.8%对17.3%,p<0.001),以及非计划就诊率(82.6%对14.8%,p<0.001)。虽然下腔静脉扩张对主要结局的敏感性较高,但VExUS表现出更高的特异性,尤其是在中重度三尖瓣反流(TR)患者中。
在这项探索性分析中,VExUS评分升高与不良短期结局相关。与单独的下腔静脉直径相比,VExUS评分可能对淤血提供更特异的评估,特别是在存在显著TR的情况下,可能改善该人群的风险分层。