VExUS Score and Hepatorenal Congestion Improvements After Transcatheter Tricuspid Intervention: Clinical and Prognostic Insights.

Authors

Álvaro Rodríguez-Pérez, Chi-Hion Pedro Li, Ilana Forado-Benatar, Joan Guzman-Bofarull, Andrea Arenas-Loriente, Lluís Asmarats-Serra, Carlos Moliner-Abos, Juan Fernández-Martínez, David Viladés-Medel, Adrián Ruíz-López, Marcel Santaló-Corcoy, Alba Maestro-Benedicto, Irene Menduiña, Isabel Zegrí-Reiriz, Sonia Mirabet-Pérez, Jose A Parada-Barcia, Manuel Barreiro-Pérez, Rodrigo Estévez-Loureiro, Xavier Freixa, Igor Morr, Laura Sanchis, Omar Abdul-Jawad, Marta Sitges, Marta Farrero, Dabit Arzamendi

Published in

JACC. Cardiovascular interventions. Volume 19. Issue 15. Pages 2062-2075. Aug 10, 2026.

Abstract

Severe tricuspid regurgitation (TR) is associated with morbidity and mortality and linked to intravascular venous congestion. Venous ultrasound of the hepatic, portal, and intrarenal veins-often integrated via the Venous Excess Ultrasound (VExUS) score-offers prognostic insight in heart failure, but its utility in transcatheter tricuspid valve intervention (TTVI) remains undefined.
The aim of this study was to evaluate changes in hepatic, portal, and intrarenal venous flow before vs after TTVI, assess their durability, and explore associations with prognosis and functional status.
In this prospective multicenter cohort patients undergoing TTVI (2022-2024) were included. Venous ultrasound was performed 24 hours pre- and postprocedure. Functional status, frailty, biomarkers, venous ultrasound and echocardiography were assessed at baseline and at 1, 6, and 12 months. All-cause mortality and heart failure hospitalization were recorded. Survival was analyzed by Kaplan-Meier and Cox regression.
A total of 64 patients were included; mean age was 76.7 ± 8.1 years; 76.6% were women. Procedures included edge-to-edge repair (60.9%), percutaneous annuloplasty (18.7%), orthotopic replacement (14.1%), and heterotopic replacement (6.3%). At baseline, 70% had VExUS grade 3. Within 24 hours hepatic vein, portal pulsatility, and intrarenal venous flows improved, reclassifying 66% to VExUS ≤1, despite no change in diuretic dose or weight. Venous ultrasound improvements persisted during follow-up. Postprocedure VExUS grade 3 at 24 hours was a strong predictor of mortality (HR: 5.55; 95% CI: 1.60-19.21; P = 0.007).
TTVI improved hepatic, portal, and intrarenal venous flow within 24 hours, with sustained effects at 1 year. Postprocedure VExUS score was associated with mortality and may serve as a procedural success indicator.

PMID:
42575575
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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