Key result
VExUS score shows promise for multimodal HF congestion assessment but lacks randomized trials.
Why the study?
Clinical assessment of congestion in heart failure remains challenging because traditional approaches often fail to capture systemic venous congestion and its impact on organ function.
VExUS is a promising complementary point-of-care ultrasound tool for assessing systemic venous congestion and organ perfusion in heart failure, though randomized trial data are needed.
VExUS-guided decongestion reduces residual congestion at discharge in AHF; extends observational data with randomized evidence for bedside assessment.
Congestion is a major driver of symptoms, hospitalization, and adverse outcomes in heart failure (HF), yet its clinical assessment remains challenging. Traditional approaches based on physical examination, biomarkers, and isolated imaging surrogates often fail to capture the complexity of systemic venous congestion and its impact on organ function. In HF, congestion should be interpreted as a multifactorial process resulting from the interaction between intravascular volume burden, venous compliance, cardiac filling pressures, neurohormonal activation, blood volume redistribution, and organ-specific susceptibility. In this context, point-of-care ultrasound has emerged as a promising adjunctive tool for bedside congestion assessment. The Venous Excess Ultrasound (VExUS) score integrates inferior vena cava assessment with Doppler analysis of hepatic, portal, and intrarenal veins, allowing for the evaluation of venous pressure transmission and organ-level congestion. Observational studies suggest that VExUS and related venous Doppler abnormalities correlate with invasive hemodynamic parameters and are associated with acute kidney injury, diuretic response, heart failure hospitalization, and mortality. Serial changes in venous congestion may provide additional information regarding treatment response and clinical trajectory. However, the available evidence remains heterogeneous across acute HF, ambulatory HF, cardiorenal syndrome, and critical care populations, and randomized trials evaluating VExUS-guided management are lacking. Therefore, VExUS should be interpreted as a complementary tool within a multimodal assessment that includes echocardiography, lung ultrasound, biomarkers, renal function, urine output, physical examination, and response to therapy. By integrating fluid burden with venous pressure transmission and organ perfusion, multimodal ultrasound may support more individualized congestion assessment and risk stratification in HF.
No takes yet. Share an insight, caveat, or question.
Marchetta et al. (2026) conducted a review in Heart failure. Venous Excess Ultrasound (VExUS) was evaluated. The Venous Excess Ultrasound (VExUS) score is a promising adjunctive tool for multimodal congestion assessment in heart failure, though randomized trials evaluating its clinical impact are lacking.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: