Phenotyping of Congestion in Decompensated Heart Failure: Life-Saving Accuracy

Diagnosing heart failure (HF) in patients with multiple comorbidities continues to pose a challenge, especially when overlaps with pulmonary disease, obesity, or atypical clinical presentation. In this context, complementary diagnostic tools, such as NT-proBNP and venous excess ultrasound (VExUS) score, enable earlier and more accurate assessment of congestion, reducing adverse effects and fostering timely implementation of guideline-directed medical therapy.

Management of decompensated HF becomes even more complex when there is subclinical fluid retention, a frequently underestimated condition that is associated with higher rates of hospital readmission and a comparable mortality risk to that observed in patients with clinically evident edema.^, In these scenarios, VExUS has become a central tool in the diagnostic and therapeutic arsenal, both in differentiating the etiology of dyspnea and in managing patients with overt congestion and cardiorenal syndrome, by allowing for safer and more individualized management of diuresis, minimizing the risk of kidney injury.

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