Correlation between the VExUS score and right atrial pressure: a pilot prospective observational study

Area of Science:

• Critical Care Medicine
• Cardiology
• Nephrology

Background:

• Venous congestion is a significant, yet under-recognized, cause of mortality in critically ill patients.
• Current methods for measuring venous filling pressures, like right heart catheterization (RHC), are invasive.
• Venous Excess Ultrasound (VExUS) is a novel, noninvasive scoring system using ultrasound to quantify venous congestion.

Purpose of the Study:

• To prospectively assess the correlation between the VExUS score and right atrial pressure (RAP), a key indicator of venous congestion.
• To compare the efficacy of VExUS in predicting elevated RAP against the traditional inferior vena cava (IVC) diameter measurement.
• To validate VExUS in a diverse population of critically ill patients undergoing RHC.

Main Methods:

• Prospective study involving critically ill patients undergoing RHC.
• VExUS examination, including assessment of IVC diameter and Doppler flow in hepatic, portal, and renal veins, was performed before RHC.
• Ultrasonographers were blinded to RHC results; VExUS grades were assigned prior to RHC data acquisition.

Main Results:

• A significant positive association was found between VExUS grade and RAP, even after controlling for confounders (P < 0.001, R² = 0.68).
• VExUS demonstrated a high area under the curve (AUC = 0.99) for predicting RAP ≥ 12 mmHg, outperforming IVC diameter (AUC = 0.79).
• The study confirmed a strong correlation between VExUS and RAP in a broad patient cohort.

Conclusions:

• The VExUS score strongly correlates with RAP, suggesting its utility as a reliable noninvasive measure of venous congestion.
• VExUS shows superior performance compared to IVC diameter in predicting elevated RAP.
• These findings support the use of VExUS for assessing and potentially guiding management of venous congestion across various critical illnesses.