Ramoni D, Carbone F, Montecucco F. Ultrasound unveiling: Decoding venous congestion in heart failure for precision management of fluid status. World J Cardiol 2024; 16(6): 306-309 [PMID: 38993587 DOI: 10.4330/wjc.v16.i6.306]
Corresponding Author of This Article
Fabrizio Montecucco, MD, PhD, Full Professor, Department of Internal Medicine, University of Genoa, 6 Viale Benedetto 15, Genoa 16132, Italy. fabrizio.montecucco@unige.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Davide Ramoni, Federico Carbone, Fabrizio Montecucco, Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
Federico Carbone, Fabrizio Montecucco, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
Author contributions: Ramoni D conceptualization and writing the original draft; Carbone F and Montecucco F supervised and edited the entire work; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrizio Montecucco, MD, PhD, Full Professor, Department of Internal Medicine, University of Genoa, 6 Viale Benedetto 15, Genoa 16132, Italy. fabrizio.montecucco@unige.it
Received: January 31, 2024 Revised: May 13, 2024 Accepted: June 11, 2024 Published online: June 26, 2024 Processing time: 146 Days and 1.5 Hours
Abstract
This editorial discusses the manuscript by Di Maria et al, published in the recent issue of the World Journal of Cardiology. We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome (CRS), despite its high prevalence and the substantial worsening of both kidney function and heart failure. While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure, integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions. In particular, with the assessment of Doppler patterns across multiple venous districts, the Venous Excess Ultrasound (VExUS) score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions. Integrating specific echocardiographic parameters, particularly those concerning the right heart, may thus improve the VExUS score sensitivity, offering perspective into the nuanced comprehension of cardio-renal dynamics. A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.
Core Tip: While conventional approaches of managing fluid overload in heart failure have long relied on clinical examination, there is room to incorporate patient phenotyping and predict the development of cardio-renal syndrome. We here discuss implementation of the multi-parameter Venous Excess Ultrasound scoring system, which is helpful in avoiding missteps in the assessment and therapeutic decision-making processes. Our aim is to emphasize the emerging role of these feasible, safe and low-cost tools that are easy to implement in clinical practice. Integrating echocardiographic parameters with thorough clinical assessments could provide a comprehensive approach to managing cardio-renal syndrome.
