{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T05:44:18Z","timestamp":1793339058165,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Moscow Center for healthcare innovations","award":["2412-25\/22"],"award-info":[{"award-number":["2412-25\/22"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The venous excess ultrasound score (VExUS) is used to objectify systemic venous congestion. The aim of the paper was to determine the association between VExUS grades and worsening renal function (WRF), reduced natriuretic response, diuretics resistance, and mortality in patients with acute heart failure (AHF). Methods: One hundred patients were included, and Doppler ultrasound of hepatic, portal, and renal veins was performed. Severity of congestion was graded using the VExUS score (grade 0, 1, 2, or 3). Sodium concentration in a spot urine sample was assessed in 2 h after the first loop diuretic administration and was adjusted for the prescribed dose of furosemide (31 mmol\/40 mg). Diuretics resistance was defined as the need to double the starting dose of intravenous furosemide in 6 h. Results: Patients with VExUS grade 3 showed a higher incidence of WRF (OR: 11.17; 95% CI: 3.86\u201332.29; p &lt; 0.001) and a decreased natriuretic response: a spot urine sodium content of &lt;50 mmol\/L (OR: 21.53; 95% CI: 5.32\u201387.06; p &lt; 0.001) and an adjusted spot urine sodium content of &lt;31 mmol\/40 mg (OR: 9.05; 95% CI: 3.15\u201325.96; p &lt; 0.001). The risk of diuretic resistance (OR: 15.31; 95% CI: 5.05\u201346.43; p &lt; 0.001), as well as the need for inotropic and\/or vasopressor support (OR: 11.82; 95% CI: 3.59\u201338.92; p &lt; 0.001), was higher in patients with severe congestion. The hospital mortality rate increased in patients with VExUS grade 3 compared to in patients with other grades (OR: 26.4; 95% CI: 5.29\u2013131.55; p &lt; 0.001). Conclusions: Patients with AHF and VExUS grade 3 showed a higher risk of developing WRF, a decreased diuretic and natriuretic response, a need for inotropic and\/or vasopressor support, and a poor prognosis during their hospital stay.<\/jats:p>","DOI":"10.3390\/jcm13206272","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T10:49:22Z","timestamp":1729507762000},"page":"6272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Venous Excess Ultrasound Score Is Associated with Worsening Renal Function and Reduced Natriuretic Response in Patients with Acute Heart Failure"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6311-1996","authenticated-orcid":false,"given":"Sofya","family":"Sovetova","sequence":"first","affiliation":[{"name":"City Clinical Hospital Named After S. S. Yudin, Kolomensky Passage 4, 115446 Moscow, Russia"},{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7071-5752","authenticated-orcid":false,"given":"Kristina","family":"Charaya","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4253-1646","authenticated-orcid":false,"given":"Tamerlan","family":"Erdniev","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8209-2791","authenticated-orcid":false,"given":"Dmitry","family":"Shchekochikhin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"},{"name":"City Clinical Hospital No. 1 Named After N.I. Pirogov, Leninsky Prospekt 8, 119049 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Bogdanova","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Panov","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalya","family":"Plaksina","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmira","family":"Mutalieva","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3142-619X","authenticated-orcid":false,"given":"Natalia","family":"Ananicheva","sequence":"additional","affiliation":[{"name":"City Clinical Hospital Named After S. S. Yudin, Kolomensky Passage 4, 115446 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Fomin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0276-7374","authenticated-orcid":false,"given":"Denis","family":"Andreev","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Functional and Ultrasound Diagnostics, First State Moscow University Named After I.M. Sechenov, Trubetskaya 8\/2, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4901","DOI":"10.1093\/eurheartj\/ehab670","article-title":"Corrigendum to: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1038\/s41569-020-0379-7","article-title":"Congestion in heart failure: A contemporary look at physiology, diagnosis and treatment","volume":"17","author":"Boorsma","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jchf.2017.09.023","article-title":"Integrative Assessment of Congestion in Heart Failure TORoughout the Patient Journey","volume":"6","author":"Girerd","year":"2018","journal-title":"JACC Heart Fail."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1001\/jama.1989.03420060100040","article-title":"The limited reliability of physical signs for estimating hemodynamics in cORonic heart failure","volume":"261","author":"Stevenson","year":"1989","journal-title":"J. Am. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion\u2014A position statement from the Heart Failure Association of the European Society of Cardiology","volume":"21","author":"Mullens","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13089-020-00163-w","article-title":"Quantifying systemic congestion with Point-Of-Care ultrasound: Development of the venous excess ultrasound grading system","volume":"12","author":"Rola","year":"2020","journal-title":"Ultrasound J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New Creatinine- and Cystatin C\u2013Based Equations to Estimate GFR without Race","volume":"385","author":"Inker","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/eurheartj\/ehy856","article-title":"\u2018Ten Commandments\u2019 for the Fourth Universal Definition of Myocardial Infarction 2018","volume":"40","author":"Thygesen","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1001\/jama.2016.0289","article-title":"Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Phillips","year":"2016","journal-title":"J. Am. Med. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"132456","DOI":"10.1016\/j.ijcard.2024.132456","article-title":"Diuretic resistance in acute heart failure: Proposal for a new urinary sodium-based definition","volume":"415","author":"Pellegrino","year":"2024","journal-title":"Int. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.cjco.2020.03.012","article-title":"Assessing Splanchnic Compartment Using Portal Venous Doppler and Impact of Adding It to the EVEREST Score for Risk Assessment in Heart Failure","volume":"2","author":"Bouabdallaoui","year":"2020","journal-title":"CJC Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1097\/CCM.0000000000004074","article-title":"A Novel Patient-Specific Model for Predicting Severe Oliguria; Development and Comparison With Kidney Disease: Improving Global Outcomes Acute Kidney Injury Classification","volume":"48","author":"Howitt","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/cc11454","article-title":"Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1)","volume":"17","author":"Kellum","year":"2013","journal-title":"Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1586\/14779072.2015.1087313","article-title":"Unsolved challenges in diuretic therapy for acute heart failure: A focus on diuretic response","volume":"13","author":"Vaduganathan","year":"2015","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e009961","DOI":"10.1161\/JAHA.118.009961","article-title":"Alterations in Portal Vein Flow and Intrarenal Venous Flow Are As-sociated With Acute Kidney Injury After Cardiac Surgery: A Prospective Observational Cohort Study","volume":"7","author":"Benkreira","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.cardfail.2020.06.016","article-title":"Prognostic Impact of Changes in Intrarenal Venous Flow Pattern in Patients With Heart Failure","volume":"27","author":"Yamamoto","year":"2021","journal-title":"J. Card. Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e013584","DOI":"10.1161\/JAHA.119.013584","article-title":"Doppler-Derived Renal Venous Stasis Index in the Prognosis of Right Heart Failure","volume":"8","author":"Birk","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.jchf.2023.07.015","article-title":"Intrarenal Venous Flow Pattern Changes Do Relate With Renal Function Alterations in Acute Heart Failure","volume":"12","author":"Cobo","year":"2024","journal-title":"JACC Heart Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1159\/000511714","article-title":"Dynamic Changes in Portal Vein Flow during Decongestion in Patients with Heart Failure and Cardio-Renal Syndrome: A POCUS Case Series","volume":"11","author":"Argaiz","year":"2021","journal-title":"Cardiorenal Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"783","DOI":"10.5005\/jp-journals-10071-23570","article-title":"Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study","volume":"24","author":"Bhardwaj","year":"2020","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jacc.2008.05.068","article-title":"Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure","volume":"53","author":"Mullens","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1016\/j.jacc.2016.03.537","article-title":"Cardiac Output and Renal Dysfunction","volume":"67","author":"Mullens","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Torres-Arrese, M., Mata-Mart\u00ednez, A., Luordo-Tedesco, D., Garc\u00eda-Casasola, G., Alonso-Gonz\u00e1lez, R., Montero-Hern\u00e1ndez, E., Cobo-Marcos, M., S\u00e1nchez-Sauce, B., Cuervas-Mons, V., and Tung-Chen, Y. (2023). Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study. J. Clin. Med., 12.","DOI":"10.20944\/preprints202301.0010.v1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.amjcard.2023.07.007","article-title":"Hemodynamic Evaluation of Right-Sided Congestion With Doppler Ultrasonography in Pulmonary Hypertension","volume":"203","author":"Cruz","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/ehjci\/jeac239","article-title":"How to assess systemic venous congestion with point of care ultrasound","volume":"24","author":"Denault","year":"2023","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/ejhf.35","article-title":"The kidney in congestive heart failure: \u201cAre natriuresis, sodium, and diuretics really the good, the bad and the ugly?\u201d","volume":"16","author":"Verbrugge","year":"2014","journal-title":"Eur. J. Heart Fail."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1152\/ajplegacy.1958.195.1.97","article-title":"Effect of change in renal venous pressure upon renal vascular resistance, urine and lymph flow rates","volume":"195","author":"Haddy","year":"1958","journal-title":"Am. J. Physiol. Content"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e002370","DOI":"10.1161\/CIRCHEARTFAILURE.115.002370","article-title":"Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure","volume":"9","author":"Testani","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1002\/ejhf.1428","article-title":"Serial assessment of spot urine sodium predicts effectiveness of decongestion and outcome in patients with acute heart failure","volume":"21","author":"Biegus","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.jchf.2017.05.006","article-title":"Intrarenal Flow Alterations During Transition From Euvolemia to Intravascular Volume Expansion in Heart Failure Patients","volume":"5","author":"Nijst","year":"2017","journal-title":"JACC Heart Fail."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2547","DOI":"10.1002\/jum.16288","article-title":"VExUS Score in the Management of Patients With Acute Kidney Injury in the Intensive Care Unit: AKIVEX Study","volume":"42","author":"Rihl","year":"2023","journal-title":"J. Ultrasound Med."},{"key":"ref_32","first-page":"1","article-title":"Effect on Kidney Function Recovery Guiding Deconges-tion with VExUS in Patients with Cardiorenal Syndrome 1: A Randomized Control Trial","volume":"14","author":"Rio","year":"2023","journal-title":"Cardiorenal Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1159\/000534976","article-title":"Bedside Ultrasound in the Management of Cardiorenal Syndromes: An Updated Review","volume":"13","author":"Argaiz","year":"2023","journal-title":"Cardiorenal Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/ejhf.478","article-title":"Contemporary management of acute right ventricular failure: A statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the Europe-an Society of Cardiology","volume":"18","author":"Harjola","year":"2016","journal-title":"Eur. J. Heart Fail."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/s13054-023-04471-0","article-title":"Correlation between the VExUS score and right atrial pressure: A pilot prospective observational study","volume":"27","author":"Longino","year":"2023","journal-title":"Crit. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.jchf.2016.03.016","article-title":"Clinical Implications of Intrarenal Hemodynamic Evaluation by Doppler Ultrasonography in Heart Failure","volume":"4","author":"Iida","year":"2016","journal-title":"JACC Heart Fail."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Puzzovivo, A., Monitillo, F., Guida, P., Leone, M., Rizzo, C., Grande, D., Ciccone, M.M., and Iacoviello, M. (2018). Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients. J. Cardiovasc. Dev. Dis., 5.","DOI":"10.3390\/jcdd5040052"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1093\/ehjacc\/zuad073","article-title":"Intrarenal Venous Doppler as a novel marker for optimal decongestion, patient management, and prognosis in Acute Decompensated Heart Failure","volume":"12","author":"Turrini","year":"2023","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/20\/6272\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:17:16Z","timestamp":1760113036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/20\/6272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,21]]},"references-count":38,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jcm13206272"],"URL":"https:\/\/doi.org\/10.3390\/jcm13206272","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,21]]}}}