Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.
M, M., LG, G., AR, N., F, C., GM, S., GM, F., & S, G. (2026). Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62071224
M M, LG G, AR N, F C, GM S, GM F, et al. Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.. Medicina (Kaunas, Lithuania). 2026; doi: 10.3390/medicina62071224
M M, LG G, AR N, et al. Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.[J]. Medicina (Kaunas, Lithuania). 2026. DOI: 10.3390/medicina62071224.
@article{m2026,
author = {Marchetta M and Granata LG and Napoli AR and Cipolla F and Sangiorgi GM and Francese GM and Giubilato S},
title = {Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
doi = {10.3390/medicina62071224},
note = {PMID: 42512767},
}
TY - JOUR AU - Marchetta M AU - Granata LG AU - Napoli AR AU - Cipolla F AU - Sangiorgi GM AU - Francese GM AU - Giubilato S TI - Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS. T2 - Medicina (Kaunas, Lithuania) PY - 2026 DO - 10.3390/medicina62071224 AN - PMID:42512767 ER -
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.