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Updated: Sep 8, 2025

Demystifying Venous Excess Ultrasound (VExUS): Image Acquisition and Interpretation
Published on: May 16, 2025
Venous excess ultrasound and right heart catheterization in pre-capillary pulmonary hypertension
Sergio M Alday-Ramírez1, César A Gómez-Rodríguez1, Félix Damas-de-Los-Santos2
1Department of Echocardiography, Instituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030, Mexico City, México.
Aims:
Venous congestion is an important determinant of organ dysfunction in patients with pulmonary hypertension. Currently, there are no optimal methods for non-invasive assessment of venous congestion. We aimed to evaluate the accuracy of the recently described venous excess ultrasound grading system (VExUS) to determine the presence of venous congestion in patients with precapillary pulmonary hypertension compared to right heart catheterization.
Methods:
We included patients with precapillary pulmonary hypertension undergoing right heart catheterization. VExUS was performed by trained cardiologists simultaneous with catheterization. Correlation and simple logistic regression between invasive hemodynamic measurement and VExUS was performed.
Results:
Forty-nine patients with precapillary pulmonary hypertension were included. A significant correlation between VExUS and right atrial pressure (RAP) was found (R = 0.70, p < 0.001). VExUS was an excellent predictor of RAP > 10 mmHg (AUC 0.93, p < 0.001).
Conclusion:
Our study provides evidence that VExUS score is a reliable, non-invasive method for assessing right atrial pressure in patients with pre-capillary PH.
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