This multicenter observational study evaluated the accuracy of the VExUS score (grades 0–3, based on IVC diameter/collapsibility and Doppler of hepatic, portal, and intrarenal veins) for predicting invasively measured right atrial pressure (RAP) in 187 patients referred for pulmonary hypertension (PH) across 7 Italian centers, with right heart catheterization performed within 1 hour of VExUS assessment.
VExUS grade showed a strong graded association with RAP (grade 0: 3.9 mmHg; grade 1: 8.4 mmHg; grade 2: 13.5 mmHg; grade 3: 15.8 mmHg; p<0.001). For detecting RAP >12 mmHg, the VExUS score achieved an AUC of 0.97 (95% CI 0.94–0.99), outperforming isolated echocardiographic markers and performing comparably to full echocardiographic RAP estimation, consistently across pre-capillary, post-capillary, and no-PH subgroups.
Single-country (Italian) multicenter design limits generalizability. The study population skewed heavily toward pre-capillary PH (primarily PAH), with only 21 post-capillary PH and 21 no-PH patients, reducing power in subgroup comparisons. Observational design cannot establish causality or evaluate VExUS-guided management outcomes.
VExUS scoring is a highly accurate, non-invasive bedside tool for detecting elevated RAP (>12 mmHg) in PH patients and can complement or rival echocardiographic RAP estimates. Clinicians managing PH should consider integrating VExUS into routine congestion assessment, especially when full echocardiography is not immediately available.
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