Abstract
Background: Residual systemic congestion is common after treatment for acute decompensated heart failure (ADHF) and remains difficult to assess non-invasively. We investigated internal jugular vein distensibility (DIJV) as a dynamic marker of residual congestion and its association with established congestion parameters and clinical outcomes. Methods: In this prospective single-center study, 112 patients hospitalized with ADHF underwent clinical, laboratory, echocardiographic, and venous ultrasound assessment at admission and after decongestive treatment. DIJV was calculated as the ratio of maximal internal jugular vein diameter during Valsalva to resting diameter, with DIJV ≥ 4 indicating preserved distensibility. Results: At the final in-hospital assessment, 59 patients (52.7%) had persistent DIJV < 4. These patients had higher NT-proBNP, larger inferior vena cava diameter, greater portal vein pulsatility, higher pulmonary artery systolic pressure, and lower TAPSE/PASP compared with patients with preserved DIJV. They also had longer hospital stays and higher rates of ADHF rehospitalization and six-month mortality. Higher admission DIJV remained associated with lower odds of six-month ADHF rehospitalization after multivariable adjustment (OR 0.31 per 1-unit increase, 95% CI 0.15–0.59; p < 0.001). Conclusions: DIJV improves with decongestive treatment, but frequently remains impaired. Persistent impairment is associated with a broader residual-congestion profile and adverse clinical outcomes, supporting DIJV as a simple, dynamic adjunct to multiparametric congestion assessment.