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

Abstract

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.