Multimodal analysis of congestion and prognostic utility of the VExUS protocol in hospitalized heart failure patients at a tertiary care hospital

Abstract

Background

Multimodal assessment of congestion and venous excess ultrasound protocol (VExUS) play a determinant role for volume assessment and decongestive therapy in patients with acute heart failure (AHF).

Methods

Prospective, unicentrical and observational study in patients admitted for AHF at the Internal Medicine ward, designed to explore the prevalence, predictors and clinical outcomes of congestion (VExUS score) and the prevalence of congestive nephropathy.

Results

A total of 100 patients were included (mean age 86 ± 8 years were and 51% females). According to VExUS protocol, 49% exhibited moderate to severe congestion (VExUS 2-3). These patients were more clinical congested, showed higher concentrations of CA125 and microalbumin/creatinine ratio, and need greater doses of loop diuretics during hospitalization. The prevalence of congestive nephropathy on admission was 38%. Patients with VExUS score on admission ≥ 2 had a 2.5-fold increased risk for all-cause mortality and/or HF hospitalization at 1 year (OR 2.52, 95% CI 1.02–6.26, p = 0.046). In multivariable analysis elevated urea levels, larger inferior vena cava diameter and male gender, were identified as independent predictors on top of VExUS score for one-year mortality with an area under the curve for the final model of 0.740 (p < 0.001).

Conclusions

Moderate to severe congestion (VExUS grade 2-3) is associated with higher clinical congestion scores, greater need for diuretic treatment, and worse clinical outcomes, including increased mortality and rehospitalization rates in AHF. Furthermore, one-third of AHF showed congestion nephropathy a situation with clinical relevance that can influence decongestive treatments and final outcomes.