VExUS Ultrasound score by point of care ultrasound to quantify venous congestion in patients with acute decompensated heart failure

Einleitung und Fragestellung Heart failure (HF) is one of the most common admission diagnoses in internal medicine. Acute kidney injury (AKI) is common in acute decompensated HF – mostly due to reduced perfusion pressure. Although venous congestion is thought to have a greater influence in ADHF AKI, hemodynamic focus often remains on the diminished mean arterial pressure, based on low cardiac output. The aim of our study was, to evaluate the feasibility of using the venous excess ultrasound score (VExUS-Score) in patients with acute decompensated heart failure to assess resuscitation.

Material und Methodik The VExUS score examines and classifies the inferior vena cava diameter and the PW-Doppler flow profiles of the hepatic vein, portal vein and intrarenal vein. Measurements were performed using a portable handheld point of care ultrasound (POCUS) device on hospital admission and before discharge. The flow curves were analyzed against clinical parameters of decompensation. Enrolled patients were examined at their bedside within the first 24 hours after hospital admission and before discharge.

Ergebnisse 30 patients were included in the study; 16 patients had full data set. Mean age was 74.6±14.3 years. 93.7% of patients admitted had dyspnea of at least NYHA III. Ankle edema was present in 56.2%. The first VExUS examination was performed at an average of 11.9±9.5 hours after hospital admission. Overall, there was a decease in VExUS from admission (1.0 [0.25-2.00]) to discharge (0 [0-0.75], p=.008). Out of 16 patients, 10 decreased by≥one VExUS category. Change in VExUS score did not correlate with parameters of decompensation including change in BMI, eGFR, serum creatinine and cumulative diuretics (all p>0.5).

Zusammenfassung The POCUS examinations have shown that a bedside collection of the VExUS is feasible. The non-significance of the results compared to decompensation and venous congestion parameters may be attributed to the small study population.

Publication History

Article published online:
29 August 2023