Dataset Information

Evaluation of Venous Congestion Using Beside Ultrasonography by the Nephrology Consultant: The VExUS Nexus.

ABSTRACT: In patients with heart failure and cardiorenal syndrome, lingering congestion is associated with worse outcomes. As such, titrating diuretic or ultrafiltration therapy based on objective assessment of volume status plays a crucial role in the management of these patients. Conventional physical examination findings and parameters such as daily weight measurement are not always reliable in this setting. Recently, point of care ultrasonography (POCUS) has emerged as an attractive enhancement to bedside clinical examination in assessing fluid volume status. Specifically, Doppler ultrasound of the major abdominal veins gives additional information about end-organ congestion when used in conjunction with inferior vena cava ultrasound. Moreover, these Doppler waveforms can be monitored in real time to gauge the efficacy of decongestive therapy. Herein, we present a case that illustrates the utility of POCUS in the management of a patient with heart failure exacerbation.

SUBMITTER: Koratala A

PROVIDER: S-EPMC9994295 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Evaluation of Venous Congestion Using Beside Ultrasonography by the Nephrology Consultant: The VExUS Nexus.

Koratala Abhilash A

POCUS journal 20220201 Kidney

In patients with heart failure and cardiorenal syndrome, lingering congestion is associated with worse outcomes. As such, titrating diuretic or ultrafiltration therapy based on objective assessment of volume status plays a crucial role in the management of these patients. Conventional physical examination findings and parameters such as daily weight measurement are not always reliable in this setting. Recently, point of care ultrasonography (POCUS) has emerged as an attractive enhancement to bed ...[more]

PMID: 36896109

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Project description:BackgroundVenous excess ultrasound (VExUS) is a novel ultrasound technique previously reported as a noninvasive measure of venous congestion and predictor of cardiorenal acute kidney injury.Research questionAre there associations between VExUS grade and cardiac pressures measured by right heart catheterization (RHC) and cardiac biomarkers and clinical outcomes in patients undergoing RHC?Study design and methodsWe conducted a prospective cohort study at the Denver Health Medical Center from December 20, 2022, to March 25, 2023. All patients undergoing RHC underwent a blinded VExUS assessment prior to their procedure. Multivariable regressions were conducted to assess relationships between VExUS grade and cardiac pressures, biomarkers, and changes in weight among patients with heart failure, a proxy for diuretic success. Receiver operating characteristic curve and area under the curve (AUC) were derived for VExUS, inferior vena cava (IVC) diameter, and IVC collapsibility index (ICI) to predict right atrial pressure (RAP) > 10 and < 7 mm Hg.ResultsAmong 81 patients, 45 of whom were inpatients, after adjusting for age, sex, and Charlson Comorbidity Index, there were significant relationships between VexUS grade of 2 (β = 4.8; 95% CI, 2.6-7.1; P < .01) and 3 (β = 11; 95% CI, 8.9-14; P < .01) and RAP, VExUS grade of 2 (β = 6.8; 95% CI, 0.16-13; P = .045) and 3 (β = 15; 95% CI, 7.3-22; P < .01) and mean pulmonary artery pressure, and VExUS grade of 2 (β = 7.0; 95% CI, 3.9-10; P < .01) and 3 (β = 13; 95% CI, 9.5-17; P < .01) and pulmonary capillary wedge pressure. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP > 10 mm Hg were 0.9 (95% CI, 0.83-0.97), 0.77 (95% CI, 0.68-0.88), and 0.65 (95% CI, 0.52-0.78), respectively. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP < 7 mm Hg were 0.79 (95% CI, 0.70-0.87), 0.74 (95% CI, 0.64-0.84), and 0.62 (95% CI, 0.49-0.76), respectively. In a subset of 23 patients with heart failure undergoing diuresis, there was a significant association between VExUS grade 3 and change in weight between time of RHC and discharge (P = .025).InterpretationAlthough more research is required, VExUS has the potential to increase diagnostic and therapeutic capabilities of physicians at the bedside and increase our understanding of the underappreciated problem of venous congestion.

Dataset Information

Evaluation of Venous Congestion Using Beside Ultrasonography by the Nephrology Consultant: The VExUS Nexus.

Publications

Evaluation of Venous Congestion Using Beside Ultrasonography by the Nephrology Consultant: The VExUS Nexus.

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