Point-of-Care Ultrasound for Monitoring Congestion and Guiding Decongestion Therapy in Heart Failure: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.53.69770Keywords
acute heart failure, heart failure, point-of-care ultrasound, Congestion, decongestion therapy, POCUSAbstract
Background: Heart failure (HF) remains one of the leading causes of hospitalization worldwide. Accurate assessment of congestion is crucial for optimal management, yet traditional diagnostic approaches such as physical examination, chest radiography, and natriuretic peptide measurements have limited sensitivity for detecting early or subclinical congestion. Point-of-care ultrasonography (POCUS) has emerged as a promising bedside tool that allows rapid and repeatable assessment of pulmonary and systemic congestion.
Aim: This review aims to summarize the current evidence regarding the use of point-of-care ultrasonography in monitoring congestion and guiding decongestion therapy in patients with heart failure.
Material and methods: A structured literature search was conducted across three major databases: PubMed, SciSpace (Basic and Full Text), and Google Scholar. The search strategy employed Boolean operators combining Medical Subject Headings (MeSH) and relevant keywords related to heart failure, point-of-care ultrasound, lung ultrasound, and decongestion therapy. Retrieved publications were screened for relevance and duplicates were removed.
Results: The initial search identified 685 records. After deduplication and relevance assessment, 211 unique publications were identified and compiled into a structured database. The 30 most relevant studies formed the primary evidence base for this narrative review. The available evidence suggests that POCUS particularly lung ultrasound and inferior vena cava assessment may improve detection of congestion and support optimization of decongestion therapy in HF patients.
Conclusions: Current evidence indicates that integration of POCUS into HF management may enhance monitoring of congestion and potentially improve therapeutic decision-making. However, further prospective studies and standardized clinical protocols are required to confirm its impact on clinical outcomes.
References
[1] Li, X., et al. "Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis." Frontiers in Cardiovascular Medicine, 2022. https://doi.org/10.3389/fcvm.2022.943633
[2] Al-Sagban A, M., też al. “Lung ultrasound-guided decongestion in heart failure patients: A systematic review and meta-analysis of randomized controlled trials. J Crit Care, 2026. https://doi.org/10.1016/j.jcrc.2026.155435.
[3] Burgos, L. M., et al. "Design and rationale of the inferior vena CAVA and Lung UltraSound-guided therapy in Acute Heart Failure (CAVAL US-AHF Study): a randomised controlled trial." Open Heart, vol. 9, 2022. https://doi.org/10.1136/openhrt-2022-002105
[4] Kashoob, M., et al. "LUDT-ADHF trial: Lung ultrasound-guided diuretic therapy for hospitalized patients with acute decompensated heart failure: An open-label clinical trial." Heart & Lung, 2024. https://doi.org/10.1016/j.hrtlng.2024.10.001
[5] Mhanna, M., et al. "Lung ultrasound-guided management to reduce hospitalization in chronic heart failure: a systematic review and meta-analysis." Heart Failure Reviews, 2021. https://doi.org/10.1007/S10741-021-10085-X
[6] Pargaonkar, S., et al. "Abstract 4143488: POCUS Guided Diuresis in Acute Decompensated Heart Failure – Quality Improvement in the Cardiac Care Unit." Circulation, vol. 150, 2024. https://doi.org/10.1161/circ.150.suppl_1.4143488
[7] Longino, A., et al. "Venous Excess Ultrasound (VExUS) for Screening and Management of Acute Decompensated Heart Failure: A Prospective Observational Study," 2025. https://doi.org/10.1101/2025.09.17.25335674
[8] Faragli, A., et al. "The role of non-invasive devices for the telemonitoring of heart failure patients." Heart Failure Reviews, 2021. https://doi.org/10.1007/S10741-020-09963-7
[9] Li, X., et al. "Lung ultrasound guided therapy for heart failure: an updated meta-analyses and trial sequential analysis," 2022. https://doi.org/10.37766/inplasy2022.2.0124
[10] Josa-Laorden, C., et al. "The role of intra-abdominal pressure and point of care ultrasound to guide decongestive therapies in acute heart failure." ESC Heart Failure, 2025. https://doi.org/10.1002/ehf2.15380
[11] Samir, S., et al. "Systematic implementation of cardiopulmonary ultrasound imaging to optimize management of acute decompensated heart failure." The Egyptian Heart Journal, vol. 76, 2024. https://doi.org/10.1186/s43044-024-00529-8
[12] Yampolsky, M., et al. "Point of Care Ultrasound for Diagnosis and Management in Heart Failure: A Targeted Literature Review." POCUS Journal, vol. 9, no. 1, 2024. https://doi.org/10.24908/pocus.v9i1.16795
[13] Torres-Macho, J., et al. "The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial." Journal of Clinical Medicine, vol. 11, 2022. https://doi.org/10.3390/jcm11164930
[14] Martindale, J. L. "Resolution of sonographic B-lines as a measure of pulmonary decongestion in acute heart failure." American Journal of Emergency Medicine, 2016. https://doi.org/10.1016/J.AJEM.2016.03.043
[15] Wang, Y., et al. "Prognostic Value of Lung Ultrasound for Clinical Outcomes in Heart Failure Patients: A Systematic Review and Meta-Analysis," 2022. https://doi.org/10.6084/m9.figshare.19900984
[16] Wang, Y., et al. "Prognostic Value of Lung Ultrasound for Clinical Outcomes in Heart Failure Patients: A Systematic Review and Meta-Analysis." Arquivos Brasileiros de Cardiologia, 2021. https://doi.org/10.36660/ABC.20190662
[17] Wang, Y., et al. "Prognostic Value of Lung Ultrasound for Clinical Outcomes in Heart Failure Patients: A Systematic Review and Meta-Analysis," 2021. https://doi.org/10.6084/m9.figshare.14278002
[18] Brann, A., et al. "Biomarkers of Hemodynamic Congestion in Heart Failure." Current Heart Failure Reports, 2024. https://doi.org/10.1007/s11897-024-00684-8
[19] Zito, A., et al. "Device-based remote monitoring strategies for guided management of patients with heart failure: a systematic review and meta-analysis." European Heart Journal, vol. 43, 2022. https://doi.org/10.1093/eurheartj/ehac544.1038
[20] Suhardi, M. S., et al. "Quantification of residual pulmonary congestion defined by B-line findings on lung ultrasound to predict cardiovascular events in acute heart failure: A systematic review and meta analysis." Indian Heart Journal, 2025. https://doi.org/10.1016/j.ihj.2025.05.003
[21] Gudlawar, R., et al. "Supplementary Material for: Venous Excess Doppler Ultrasound (VExUS): a Visual Guide to Decongestion in Cardiorenal syndrome," 2023. https://doi.org/10.6084/m9.figshare.24241252
[22] Ricci, F., et al. "Management of acute heart failure: Contribution of daily bedside echocardiographic assessment on therapy adjustment with impact measure on the 30-day readmission rate (JECICA)." Contemporary Clinical Trials Communications, vol. 11, 2018. https://doi.org/10.1016/J.CONCTC.2018.07.006
[23] Koratala, A. "Evaluation of Venous Congestion Using Beside Ultrasonography by the Nephrology Consultant: The VExUS Nexus." POCUS Journal, vol. 7, 2022. https://doi.org/10.24908/pocus.v7iKidney.15341
[24] Gudlawar, R., et al. "Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome." Case Reports in Nephrology and Dialysis, 2023. https://doi.org/10.1159/000531709
[25] Koratala, A., et al. "Need for Objective Assessment of Volume Status in Critically Ill Patients with COVID-19: The Tri-POCUS Approach." CardioRenal Medicine, vol. 10, 2020. https://doi.org/10.1159/000508544
[26] Bailón, M. M., et al. "Effect of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Randomized, Multicenter Trial (EPICC Study)." Cardiovascular Drugs and Therapy, 2019. https://doi.org/10.1007/S10557-019-06891-Z
[27] Bitar, Z., et al. "Ultrasound indicators of organ venous congestion: a narrative review." Annals of Intensive Care, vol. 15, 2025. https://doi.org/10.1186/s13613-025-01609-x
[28] Dubón-Peralta, K. E., et al. "Prognostic value of B lines detected with lung ultrasound in acute heart failure. A systematic review." Journal of Clinical Ultrasound, 2021. https://doi.org/10.1002/JCU.23080
[29] Kapelios, C. J., et al. "Effect of mineralocorticoid receptor antagonists on cardiac function in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials." Heart Failure Reviews, 2019. https://doi.org/10.1007/s10741-018-9758-0
[30] Dubón-Peralta, K. E., et al. "Prognostic value of B lines detected with lung ultrasound in acute heart failure. A systematic review." Journal of Clinical Ultrasound, 2022. https://doi.org/10.1002/jcu.23080
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Copyright (c) 2026 Mateusz Bernad, Katarzyna Widomska, Aleksandra Bender, Paulina Walczak, Małgorzata Niewęgłowska, Bartłomiej Szymulewicz, Kacper Dąbrowski, Jakub Łukaszewicz, Oliwia Krazińska, Magdalena Gałach, Aniela Figiel, Paweł Zaborek, Justyna Pestka, Robert Marguła, Michał Woźniak
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