Venous Excess Ultrasound (VExUS) for Screening and Management of Acute Decompensated Heart Failure: A Prospective Observational Study

BackgroundBedside assessment of venous congestion is critical in the management of acute decompensated heart failure (ADHF. Conventional methods such as physical exam and laboratory tests have limited precision. Venous Excess Ultrasound (VExUS), a Doppler-based protocol assessing hepatic, portal, and renal venous flow, offers a promising, noninvasive method for evaluating systemic congestion. ObjectivesTo evaluate the utility of VExUS in screening for cardiomyopathy, guiding diuresis, and predicting acute kidney injury (AKI) among emergency department (ED) patients admitted with suspected ADHF. MethodsWe conducted a prospective observational study at a public tertiary care center from July 2024 to April 2025, enrolling adults with suspected ADHF. Serial VExUS scans were performed from ED arrival through discharge. Primary outcomes included diagnosis of heart failure with reduced ejection fraction (HFrEF), AKI per KDIGO criteria, and change in serum creatinine following diuresis using multivariable regression and Receiver Operating Characteristic curves. ResultsNinety-nine patients were included; 287 VExUS scans were analyzed. Admission VExUS grade predicted HFrEF (McFaddens R2 = 0.3, p = 0.007) and correlated with both left ventricular ejection fraction (adjusted R2 = 0.3) and right ventricular dysfunction. VExUS grade decreased with net fluid loss (p < 0.001) and was associated with admission AKI (p = 0.01). Among patients diuresed with AKI, VExUS grade predicted creatinine trajectory (p = 0.01). ConclusionsVExUS is a promising bedside tool for real-time assessment of venous congestion in ADHF. It may aid in diagnosis, guide diuretic therapy, and identify patients at risk for cardiorenal syndrome.