{"id":"2f27d43301c1","type":"article","url":"https://hartvaat.nl/2026/06/24/vexus-scoring-biedt-completer-beeld-van-congestie-bij-hartfalen/","title":"VExUS-scoring biedt completer beeld van congestie bij hartfalen","title_en":"Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Medicina (Kaunas, Lithuania)","doi":"10.3390/medicina62071224","source_url":"https://doi.org/10.3390/medicina62071224","authors":["Marcello Marchetta","Lucio Giuseppe Granata","Anna Rosa Napoli","Fabiana Cipolla","Giuseppe Massimo Sangiorgi","Giuseppina Maura Francese","Simona Giubilato"],"significance":5,"published":"2026-08-08","source_date":"2026-06-24","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/","https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"Congestion drives symptoms and hospitalizations in heart failure, yet bedside assessment remains challenging. This narrative review discusses the Venous Excess Ultrasound (VExUS) score, which integrates inferior vena cava, hepatic, portal, and intrarenal Doppler assessments to better capture venous pressure transmission and end-organ impact. Observational data link VExUS abnormalities to invasive hemodynamics, acute kidney injury, and mortality, but randomized trials are still lacking. The authors recommend VExUS as a complementary tool within a multimodal congestion assessment strategy.","created":"2026-08-01T01:20:22Z","updated":"2026-08-10T10:36:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Congestie is een belangrijke drijver van symptomen en heropnames bij hartfalen, maar de klinische beoordeling blijft complex. Dit narratieve overzicht bespreekt hoe de Venous Excess Ultrasound (VExUS)-score, die de onderhuidse ader, lever, portaalader en nieraders combineert, een completer beeld geeft van veneuze druk en orgaanschade dan traditionele methoden. Observatieonderzoek toont correlaties met invasieve hemodynamiek, acute nierfunctievermindering en mortaliteit, maar gerandomiseerde trials ontbreken nog. VExUS wordt daarom gepresenteerd als een waardevol aanvullend hulpmiddel binnen een multimodale aanpak van congestie bij hartfalen.","abstract_original":"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."}