Point-of-Care Ultrasound (POCUS) to Assess Volume Status in Hospitalized Patients with Acute Decompensated Congestive Heart Failure

Accurate assessment of volume status in acute decompensated heart failure (ADHF) remains challenging. Point-of-care ultrasound (POCUS) offers a rapid, non-invasive approach to directly evaluate venous and pulmonary congestion. In this exploratory study, 25 veterans admitted with ADHF underwent serial POCUS examinations of jugular venous pressure (JVP), inferior vena cava (IVC) diameter and collapsibility, and pulmonary B-lines. Pulmonary B-lines were measured using a novel 4-quadrant method. Daily clinical assessments and laboratory data were used to adjudicate volume status. Associations between POCUS findings and clinical congestion were analyzed using chi-square testing. Twenty-four patients were included in the final analysis (mean age 76 years; 96% male; mean BMI 30.86 kg/m2). Elevated JVP on POCUS (≥10 cm H2O) and IVC diameter > 21 mm were strongly associated with clinical volume overload (p < 0.001 for both). B-lines showed no significant association (p = 0.806). Obesity limited bedside JVP evaluation but did not affect POCUS JVP acquisition. Combined JVP + IVC positivity produced the highest diagnostic concordance with overload status (p <0.001). POCUS assessment of JVP and IVC diameter provided a feasible and reliable method for evaluating congestion in hospitalized patients with ADHF. A novel four-quadrant method of lung ultrasound offered limited additional value.