VExUS Protocol Along Cardiorenal Syndrome: An Updated Review

Abstract

Heart failure (HF) is a major cause of hospitalization, often leading to acute kidney injury (AKI) due to venous congestion. The Venous Excess Ultrasound (VExUS) score, introduced by Beaubin-Souligny, is a bedside tool for assessing congestion severity and guiding decongestive therapy. VExUS has demonstrated prognostic value in predicting AKI, HF readmission, and mortality. Indeed, guiding decongestive therapy through the VExUS score has been shown to significantly improve the likelihood of achieving faster decongestion. Objectives: This review aims to discuss the potential role of VExUS and analyze the recent findings about its relevance in guiding decongestive therapy in patients with acute decompensated HF. Methods: A comprehensive literature review was conducted, which identified journal articles focused on VExUS and manual reviews of relevant peer-reviewed journals. Conclusions: VExUS is a promising tool for evaluating venous congestion in cardiorenal patients, thereby improving fluid and diuretic management. It provides real-time, non-invasive monitoring that enhances clinical decision-making. However, its accuracy depends on operator expertise, and further research is needed to validate its application across different patient populations.

Keywords: Venous Excess Ultrasound; acute kidney injury; cardiorenal syndrome; chronic kidney disease; heart failure; right atrial pressure.

Figure 1

VExUS score grading. Figure created with Biorender. a wave: atrial contraction; S wave: ventricular systole; D wave: ventricular diastole.

Figure 2

Illustration of AKI with secondary HF due to volume overload. Figure created with Biorender.

Figure 3

Associations between VExUS grade and intracardiac pressures measured by right heart catheterization. Figure created with Biorender and adjusted Longino A et al. [39].