Multiorgan Congestion Assessment by Venous Excess Ultrasound Score in Acute Heart Failure - 02/10/24

Doi : 10.1016/j.echo.2024.05.011

Vasileios Anastasiou, MD, MSc ^a, Emmanouela Peteinidou, MD, MSc ^a, Dimitrios V. Moysidis, MD, MSc ^b, Stylianos Daios, MD, MSc ^a, Christos Gogos, MD, MSc ^a, Alexandros C. Liatsos, MD ^a, Matthaios Didagelos, MD, PhD ^a, Thomas Gossios, MD, PhD ^a, Georgios K. Efthimiadis, MD, PhD ^a, Theodoros Karamitsos, MD, PhD ^a, Victoria Delgado, MD, PhD ^c, Antonios Ziakas, MD, PhD ^a, Vasileios Kamperidis, MD, MSc, PhD ^a,^⁎
^a First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
^b 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
^c Department of Cardiology, Hospital University Germans Trias i Pujol, Barcelona, Spain

^∗Reprint requests: Vasileios Kamperidis, MD, MSc, PhD, FESC, FEACVI, First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Greece 54636, Thessaloniki, Greece.First Department of CardiologySchool of MedicineFaculty of Health SciencesAristotle University of ThessalonikiAHEPA HospitalSt. Kiriakidi 1GreeceThessaloniki54636Greece

Abstract

Background

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).

Methods

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.

Results

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 (Δx² = +8.44, P = .03) for in-hospital mortality, whereas other indices of venous congestion (right atrial function, inferior vena cava size) did not.

Conclusions

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.

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Graphical abstract

Central Illustration. Excess venous congestion in acute HF by VExUS score was independently associated with elevated left ventricular filling pressures and adverse RV remodeling (left panel) and had incremental value over IVC diameter to predict in-hospital mortality (right panel). PF, Pulsatility fraction; TR, tricuspid regurgitation.

Central illustration :

Excess venous congestion in acute HF by VExUS score was independently associated with elevated left ventricular filling pressures and adverse RV remodeling (left panel) and had incremental value over IVC diameter to predict in-hospital mortality (right panel). PF, Pulsatility fraction; TR, tricuspid regurgitation.

Central illustrationExcess venous congestion in acute HF by VExUS score was independently associated with elevated left ventricular filling pressures and adverse RV remodeling (left panel) and had incremental value over IVC diameter to predict in-hospital mortality (right panel). PF, Pulsatility fraction; TR, tricuspid regurgitation.

Le texte complet de cet article est disponible en PDF.

Highlights

•	Systemic congestion assessment is challenging and relies on clinical judgment.
•	VExUS score allows multiorgan venous congestion assessment by ultrasonography.
•	VExUS score is feasible and can classify the degree of congestion in acute HF.
•	High VExUS score is linked with high E/e’ ratio and impaired RV and RA function.
•	VExUS score allows refined prediction of in-hospital mortality in acute HF.