{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:49:59Z","timestamp":1782287399814,"version":"3.54.5"},"reference-count":85,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Congestion is a major driver of symptoms, hospitalization, and adverse outcomes in heart failure (HF), yet its clinical assessment remains challenging. Traditional approaches based on physical examination, biomarkers, and isolated imaging surrogates often fail to capture the complexity of systemic venous congestion and its impact on organ function. In HF, congestion should be interpreted as a multifactorial process resulting from the interaction between intravascular volume burden, venous compliance, cardiac filling pressures, neurohormonal activation, blood volume redistribution, and organ-specific susceptibility. In this context, point-of-care ultrasound has emerged as a promising adjunctive tool for bedside congestion assessment. The Venous Excess Ultrasound (VExUS) score integrates inferior vena cava assessment with Doppler analysis of hepatic, portal, and intrarenal veins, allowing for the evaluation of venous pressure transmission and organ-level congestion. Observational studies suggest that VExUS and related venous Doppler abnormalities correlate with invasive hemodynamic parameters and are associated with acute kidney injury, diuretic response, heart failure hospitalization, and mortality. Serial changes in venous congestion may provide additional information regarding treatment response and clinical trajectory. However, the available evidence remains heterogeneous across acute HF, ambulatory HF, cardiorenal syndrome, and critical care populations, and randomized trials evaluating VExUS-guided management are lacking. Therefore, VExUS should be interpreted as a complementary tool within a multimodal assessment that includes echocardiography, lung ultrasound, biomarkers, renal function, urine output, physical examination, and response to therapy. By integrating fluid burden with venous pressure transmission and organ perfusion, multimodal ultrasound may support more individualized congestion assessment and risk stratification in HF.<\/jats:p>","DOI":"10.3390\/medicina62071224","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:37:17Z","timestamp":1782279437000},"page":"1224","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1243-0600","authenticated-orcid":false,"given":"Marcello","family":"Marchetta","sequence":"first","affiliation":[{"name":"Cardiology Division, Tor Vergata Hospital, 00133 Rome, Italy"},{"name":"Institute of Cardiovascular Disease of Sremska Kamenica, 21204 Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7191-9595","authenticated-orcid":false,"given":"Lucio Giuseppe","family":"Granata","sequence":"additional","affiliation":[{"name":"Cardiology Division, Garibaldi-Nesima Hospital, ARNAS Garibaldi, 95122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Rosa","family":"Napoli","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital \u201cG. Martino\u201d, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiana","family":"Cipolla","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital \u201cG. Martino\u201d, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Massimo","family":"Sangiorgi","sequence":"additional","affiliation":[{"name":"Cardiology Division, Tor Vergata Hospital, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina Maura","family":"Francese","sequence":"additional","affiliation":[{"name":"Cardiology Division, Garibaldi-Nesima Hospital, ARNAS Garibaldi, 95122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1915-585X","authenticated-orcid":false,"given":"Simona","family":"Giubilato","sequence":"additional","affiliation":[{"name":"Cardiology Division, Cannizzaro Hospital, 95126 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur. 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