Venous congestion on the VExUS scale in patients with decompensated heart failure

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Persistent venous congestion in patients with decompensated heart failure (DCHF) increases the risk of rehospitalization and death. VExUS protocol that evaluates the systemic hepatic-renal congestion in addition to assessing the inferior vena cava is regarded as a promising non-invasive ultrasound method to assess venous congestion in these patients.


To evaluate the frequency and changes in venous congestion according to the VExUS protocol in hospitalized patients with DCHF.

Material and methods

In the single-center prospective study, we enrolled 124 patients with DCHF (average age 70±12 years, 51.6% males). All patients underwent a standard physical examination, echocardiography, assessment of pulmonary congestion using lung ultrasound, determination of NT-proBNP and sST2 levels. To identify and assess the severity of venous congestion, we measured the diameter of the inferior vena cava and evaluated the patterns of venous blood flow in the hepatic and renal veins and the portal vein pulsation index using Doppler ultrasound (according to the VExUS protocol).


At admission, venous congestion was shown in 81 (65.3%) of 124 patients with DCHF (mild in 42, moderate in 12 and severe in 27). At discharge from the hospital, venous congestion persisted in 52 (41.9%) patients (mild in 31, moderate in 13 and severe in 8). Venous congestion correlated with baseline left ventricular ejection fraction, the sum of Blines on lung ultrasound, and NT-proBNP, creatinine and uric acid levels. At discharge, there was correlation of venous congestion with the sum of B-lines and NT-proBNP level.


VExUS protocol allows for non-invasive and rapid detection of venous congestion in patients with DCHF.

Key words

Decompensated chronic heart failure, venous congestion, VExUS, NT-proBNP.