August\u00a0Longino,\u00a0Katie\u00a0Martin,\u00a0Katarina\u00a0Leyba, et al<\/h3>\n\n\n\nChest 2024; 165: 590-600<\/h3>\n\n\n\nhttps:\/\/doi.org\/10.1016\/j.chest.2023.09.029<\/a><\/h3>\n\n\n\nBackground<\/h3>\n\n\n\n
Venous excess ultrasound (VExUS) is a novel ultrasound technique<\/a> previously reported as a noninvasive measure of venous congestion<\/a> and predictor of cardiorenal acute kidney injury<\/a>.<\/p>\n\n\n\nResearch Question<\/h3>\n\n\n\n
Are there associations between VExUS grade and cardiac pressures measured by right heart catheterization<\/a> (RHC) and cardiac biomarkers and clinical outcomes in patients<\/a>undergoing RHC?<\/p>\n\n\n\nStudy Design and Methods<\/h3>\n\n\n\n
We conducted a prospective cohort study<\/a> 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<\/a> success. Receiver operating characteristic curve and area under the curve (AUC) were derived for VExUS, inferior vena cava<\/a> (IVC) diameter, and IVC collapsibility index (ICI) to predict right atrial pressure<\/a> (RAP) > 10 and < 7 mm Hg.<\/p>\n\n\n\nResults<\/h3>\n\n\n\n
Among 81 patients, 45 of whom were inpatients, after adjusting for age, sex, and\u00a0Charlson Comorbidity Index<\/a>, there were significant relationships between VexUS grade of 2 (\u03b2\u00a0= 4.8; 95% CI, 2.6-7.1;\u00a0P<\/em>\u00a0< .01) and 3 (\u03b2\u00a0= 11; 95% CI, 8.9-14;\u00a0P<\/em>\u00a0< .01) and RAP, VExUS grade of 2 (\u03b2\u00a0= 6.8; 95% CI, 0.16-13;\u00a0P<\/em>\u00a0= .045) and 3 (\u03b2\u00a0= 15; 95% CI, 7.3-22;\u00a0P<\/em>\u00a0< .01) and mean\u00a0pulmonary artery pressure<\/a>, and VExUS grade of 2 (\u03b2\u00a0= 7.0; 95% CI, 3.9-10;\u00a0P<\/em>\u00a0< .01) and 3 (\u03b2\u00a0= 13; 95% CI, 9.5-17;\u00a0P<\/em>\u00a0< .01) and\u00a0pulmonary capillary wedge pressure<\/a>. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP > 10\u00a0mm\u00a0Hg were 0.9 (95%\u00a0CI, 0.83-0.97), 0.77 (95%\u00a0CI, 0.68-0.88), and 0.65 (95%\u00a0CI, 0.52-0.78), respectively. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP\u00a0< 7\u00a0mm\u00a0Hg were 0.79 (95%\u00a0CI, 0.70-0.87), 0.74 (95%\u00a0CI, 0.64-0.84), and 0.62 (95%\u00a0CI, 0.49-0.76), respectively. In a subset of 23 patients with heart failure undergoing\u00a0diuresis<\/a>, there was a significant association between VExUS grade 3 and change in weight between time of RHC and discharge (P<\/em>\u00a0= .025).<\/p>\n\n\n\n![\"\"\/](\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055575-gr1_lrg.jpg\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055575-gr2_lrg.jpg\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055575-gr3_lrg.jpg\")
<\/figure>\n\n\n\nInterpretation<\/h3>\n\n\n\n
Although 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.<\/p>\n","protected":false},"excerpt":{"rendered":"
Critical Care: Original Research Prospective Evaluation […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25672"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672\/revisions"}],"predecessor-version":[{"id":25673,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672\/revisions\/25673"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25672"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25672"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
https:\/\/doi.org\/10.1016\/j.chest.2023.09.029<\/a><\/h3>\n\n\n\nBackground<\/h3>\n\n\n\n
Venous excess ultrasound (VExUS) is a novel ultrasound technique<\/a> previously reported as a noninvasive measure of venous congestion<\/a> and predictor of cardiorenal acute kidney injury<\/a>.<\/p>\n\n\n\nResearch Question<\/h3>\n\n\n\n
Are there associations between VExUS grade and cardiac pressures measured by right heart catheterization<\/a> (RHC) and cardiac biomarkers and clinical outcomes in patients<\/a>undergoing RHC?<\/p>\n\n\n\nStudy Design and Methods<\/h3>\n\n\n\n
We conducted a prospective cohort study<\/a> 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<\/a> success. Receiver operating characteristic curve and area under the curve (AUC) were derived for VExUS, inferior vena cava<\/a> (IVC) diameter, and IVC collapsibility index (ICI) to predict right atrial pressure<\/a> (RAP) > 10 and < 7 mm Hg.<\/p>\n\n\n\nResults<\/h3>\n\n\n\n
Among 81 patients, 45 of whom were inpatients, after adjusting for age, sex, and\u00a0Charlson Comorbidity Index<\/a>, there were significant relationships between VexUS grade of 2 (\u03b2\u00a0= 4.8; 95% CI, 2.6-7.1;\u00a0P<\/em>\u00a0< .01) and 3 (\u03b2\u00a0= 11; 95% CI, 8.9-14;\u00a0P<\/em>\u00a0< .01) and RAP, VExUS grade of 2 (\u03b2\u00a0= 6.8; 95% CI, 0.16-13;\u00a0P<\/em>\u00a0= .045) and 3 (\u03b2\u00a0= 15; 95% CI, 7.3-22;\u00a0P<\/em>\u00a0< .01) and mean\u00a0pulmonary artery pressure<\/a>, and VExUS grade of 2 (\u03b2\u00a0= 7.0; 95% CI, 3.9-10;\u00a0P<\/em>\u00a0< .01) and 3 (\u03b2\u00a0= 13; 95% CI, 9.5-17;\u00a0P<\/em>\u00a0< .01) and\u00a0pulmonary capillary wedge pressure<\/a>. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP > 10\u00a0mm\u00a0Hg were 0.9 (95%\u00a0CI, 0.83-0.97), 0.77 (95%\u00a0CI, 0.68-0.88), and 0.65 (95%\u00a0CI, 0.52-0.78), respectively. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP\u00a0< 7\u00a0mm\u00a0Hg were 0.79 (95%\u00a0CI, 0.70-0.87), 0.74 (95%\u00a0CI, 0.64-0.84), and 0.62 (95%\u00a0CI, 0.49-0.76), respectively. In a subset of 23 patients with heart failure undergoing\u00a0diuresis<\/a>, there was a significant association between VExUS grade 3 and change in weight between time of RHC and discharge (P<\/em>\u00a0= .025).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nInterpretation<\/h3>\n\n\n\n
Although 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.<\/p>\n","protected":false},"excerpt":{"rendered":"
Critical Care: Original Research Prospective Evaluation […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25672"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672\/revisions"}],"predecessor-version":[{"id":25673,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672\/revisions\/25673"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25672"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25672"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Research Question<\/h3>\n\n\n\n
Are there associations between VExUS grade and cardiac pressures measured by right heart catheterization<\/a> (RHC) and cardiac biomarkers and clinical outcomes in patients<\/a>undergoing RHC?<\/p>\n\n\n\n We conducted a prospective cohort study<\/a> 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<\/a> success. Receiver operating characteristic curve and area under the curve (AUC) were derived for VExUS, inferior vena cava<\/a> (IVC) diameter, and IVC collapsibility index (ICI) to predict right atrial pressure<\/a> (RAP) > 10 and < 7 mm Hg.<\/p>\n\n\n\n Among 81 patients, 45 of whom were inpatients, after adjusting for age, sex, and\u00a0Charlson Comorbidity Index<\/a>, there were significant relationships between VexUS grade of 2 (\u03b2\u00a0= 4.8; 95% CI, 2.6-7.1;\u00a0P<\/em>\u00a0< .01) and 3 (\u03b2\u00a0= 11; 95% CI, 8.9-14;\u00a0P<\/em>\u00a0< .01) and RAP, VExUS grade of 2 (\u03b2\u00a0= 6.8; 95% CI, 0.16-13;\u00a0P<\/em>\u00a0= .045) and 3 (\u03b2\u00a0= 15; 95% CI, 7.3-22;\u00a0P<\/em>\u00a0< .01) and mean\u00a0pulmonary artery pressure<\/a>, and VExUS grade of 2 (\u03b2\u00a0= 7.0; 95% CI, 3.9-10;\u00a0P<\/em>\u00a0< .01) and 3 (\u03b2\u00a0= 13; 95% CI, 9.5-17;\u00a0P<\/em>\u00a0< .01) and\u00a0pulmonary capillary wedge pressure<\/a>. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP > 10\u00a0mm\u00a0Hg were 0.9 (95%\u00a0CI, 0.83-0.97), 0.77 (95%\u00a0CI, 0.68-0.88), and 0.65 (95%\u00a0CI, 0.52-0.78), respectively. AUC values for VExUS, IVC diameter, and ICI as predictors of RAP\u00a0< 7\u00a0mm\u00a0Hg were 0.79 (95%\u00a0CI, 0.70-0.87), 0.74 (95%\u00a0CI, 0.64-0.84), and 0.62 (95%\u00a0CI, 0.49-0.76), respectively. In a subset of 23 patients with heart failure undergoing\u00a0diuresis<\/a>, there was a significant association between VExUS grade 3 and change in weight between time of RHC and discharge (P<\/em>\u00a0= .025).<\/p>\n\n\n\n Although 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.<\/p>\n","protected":false},"excerpt":{"rendered":" Critical Care: Original Research Prospective Evaluation […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25672"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672\/revisions"}],"predecessor-version":[{"id":25673,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25672\/revisions\/25673"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25672"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25672"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Study Design and Methods<\/h3>\n\n\n\n
Results<\/h3>\n\n\n\n
<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nInterpretation<\/h3>\n\n\n\n