Residual systemic congestion at discharge remains a major challenge in patients hospitalized with acute heart failure (HF), and identifying those at highest risk for early clinical deterioration continues to be a priority in routine care. A prospective study published in the Journal of the American Society of Echocardiography evaluated the prognostic value of Venous Excess Ultrasound (VExUS) scoring performed within 24 hours before hospital discharge in patients admitted with acute HF. 

The analysis included 428 patients with a mean age of 73.2 ± 12.1 years, of whom 58.9% were men. Ultrasonographic assessment included inferior vena cava diameter and Doppler evaluation of hepatic, portal, and renal veins, with patients stratified according to VExUS scores ranging from 0 to 3. The primary endpoint was a composite of all-cause mortality and HF rehospitalization during follow-up.
 

Findings

• During a median follow-up of 12 ± 2.6 months, 161 patients (37.6%) reached the composite endpoint of death or HF rehospitalization.
• Event rates increased progressively across higher VExUS categories (VExUS 0: 25.4%, VExUS 1: 29.7%, VExUS 2: 52.5%, VExUS 3: 68.8%; log-rank p < 0.001).
• Patients with VExUS 3 demonstrated the highest risk of adverse outcomes during follow-up.
• VExUS score remained independently associated with the primary endpoint after multivariable adjustment (adjusted HR 1.33; 95% CI 1.05-1.68; p = 0.017).
• Prognostic associations were consistent across heart failure phenotypes with reduced and preserved ejection fraction.
   

The findings suggest that discharge VExUS assessment may help identify patients with higher residual congestion burden who remain at increased risk for mortality or heart failure rehospitalization after acute HF hospitalization.