Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS

Area of Science:

• Cardiology
• Critical Care Medicine
• Medical Imaging

Background:

• Systemic venous congestion significantly impacts heart failure (HF) outcomes, but its assessment is challenging.
• Traditional methods often fail to capture the complex, multifactorial nature of congestion and its effects on organ function.
• Point-of-care ultrasound (POCUS) offers a potential solution for bedside congestion evaluation.

Purpose of the Study:

• To evaluate the utility of the Venous Excess Ultrasound (VExUS) score for assessing venous congestion in heart failure.
• To explore the correlation of VExUS findings with hemodynamic parameters and clinical outcomes.
• To determine the role of VExUS as an adjunctive tool in multimodal HF management.

Main Methods:

• The Venous Excess Ultrasound (VExUS) score was developed, integrating inferior vena cava assessment with Doppler analysis of hepatic, portal, and intrarenal veins.
• Observational studies assessed the correlation of VExUS and venous Doppler abnormalities with invasive hemodynamics.
• Studies examined associations between VExUS findings and outcomes like acute kidney injury, diuretic response, HF hospitalization, and mortality.

Main Results:

• VExUS and related venous Doppler abnormalities correlate with invasive hemodynamic parameters.
• These ultrasound findings are associated with adverse outcomes including acute kidney injury, HF hospitalization, and mortality.
• Serial VExUS assessments may provide insights into treatment response and clinical trajectory.

Conclusions:

• The VExUS score is a promising tool for evaluating venous pressure transmission and organ-level congestion in HF.
• Current evidence is heterogeneous across different HF populations, and randomized trials are lacking.
• VExUS should be integrated into a multimodal assessment strategy for individualized congestion management and risk stratification in HF.