Role of venous excess ultrasound (VExUS) protocol in grading systemic venous congestion in adult Egyptian patients with congestive heart failure: a prospective study

Abstract

Abstract Background Heart failure (HF) is a prevalent condition associated with substantial morbidity and mortality globally. Persistent congestion, particularly systemic venous congestion, can precipitate organ dysfunction and is linked to adverse clinical outcomes, including increased mortality. Understanding venous congestion is crucial for the management of many conditions; yet, assessing volume status remains challenging. Conventional bedside techniques have limitations in precisely evaluating intravascular volume. The existing gold standard for assessing volume status through right heart catheterization (RHC) is invasive, expensive, and frequently inaccessible. This approach focused on assessing the efficacy of the VExUS protocol in detecting, grading, and guiding the management of systemic venous congestion in patients with congestive heart failure. Results This study involved 100 patients with congestive heart failure to assess the severity of systemic venous congestion: On admission, on discharge (after 1 week), and at follow-up (after 1 month). At admission, none of the patients had a VExUS score of 0; 48 patients (48%) exhibited grade 1 congestion, 31 patients (31%) had grade 2, and 21 patients (21%) presented with grade 3 congestion. At discharge, 46 patients (46%) improved to a VExUS score of 0, while 34 patients (34%) remained at grade 1, 20 patients (20%) at grade 2, and none remained at grade 3. After 1 month, 80 patients (80%) achieved a VExUS score of 0, 20 patients (20%) remained at grade 1 congestion, and no patients exhibited grades 2 or 3 congestion. Upon admission, all patients across different VExUS grades demonstrated a high jugular venous pressure (JVP), elevated central venous pressure (CVP), and characteristic congestion clinical signs, along with increases in laboratory findings corresponding to the varying scores. During the follow-up period, including at discharge and after 1 month, a progressive reduction was observed in (JVP), (CVP), clinical signs, and laboratory findings parallel to the changes in VExUS score. The overall reduction in VExUS score following medical treatment, and its correlation with clinical and laboratory findings over time, was statistically significant ( p < 0.001). Conclusions VExUS is a new, promising and non-invasive ultrasound-based technique that enhances evaluation of venous congestion, thereby improving diagnostic accuracy and informing management strategies.