Incorporating the Venous Excess Ultrasound Score (VExUS Score) Into Contemporary Haemodynamic Risk Assessment in Pulmonary Arterial Hypertension: The INVEXUS-PAH Study

Istanbul University - Cerrahpasa

Status: Completed

Conditions: Pulmonary Arterial Hypertension (PAH); Pulmonary Arterial Hypertension (PAH) (WHO Group 1 PH)

Study type: Observational

Funder types: Other

Identifiers

NCT07266012

2025/618IUCIC

Details and patient eligibility

About

This prospective observational study aims to evaluate the relationship between the Venous Excess Ultrasound Score (VEXUS) and the ESC/ERS 2022 simplified four-strata risk assessment model in adult patients with World Health Organization (WHO) Group 1 pulmonary arterial hypertension (PAH). The study investigates whether VEXUS can enhance risk stratification and predict haemodynamic congestion by correlating VEXUS with functional, biochemical, and invasive haemodynamic parameters.

Full description

Pulmonary arterial hypertension (PAH) is a progressive disorder characterised by increased pulmonary vascular resistance, right ventricular overload, systemic venous congestion, and high mortality. The ESC/ERS 2022 simplified four-strata model (low, intermediate-low, intermediate-high, high risk) guides treatment decisions using WHO functional class, 6-minute walk distance, and BNP/NT-proBNP levels.

However, biochemical markers may be costly or insufficiently sensitive to early haemodynamic deterioration.

VEXUS (Venous Excess Ultrasound Score), a point-of-care ultrasonographic method assessing hepatic, portal, and renal venous Doppler patterns, has shown promise in representing venous congestion.

This study evaluates whether VEXUS correlates with ESC/ERS risk categories and invasive haemodynamic parameters including right atrial pressure, mean pulmonary arterial pressure, pulmonary vascular resistance, cardiac output, and pulmonary output. The study further aims to explore whether integrating VEXUS into PAH follow-up may strengthen risk assessment.

Enrollment: 86 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria

• Adults aged ≥18 years
• Established diagnosis of WHO Group 1 pulmonary arterial hypertension (PAH)
• Stable outpatient clinical status at the time of VExUS ultrasonography
• Venous Excess Ultrasound Score (VExUS) evaluation performed with adequate ultrasonographic acoustic windows
• Clinically indicated right heart catheterisation (RHC) performed within ±60 days of VExUS assessment
• Availability of ESC/ERS 2022 simplified risk assessment variables (WHO functional class, BNP/NT-proBNP, and 6-minute walk distance)
• Ability to provide written informed consent

Exclusion Criteria

• Pulmonary hypertension other than WHO Group 1, including:

  • PH due to left heart disease (WHO Group 2)
  • PH due to chronic lung disease or hypoxaemia (WHO Group 3)
  • Chronic thromboembolic pulmonary hypertension (CTEPH; WHO Group 4)
  • Multifactorial PH (WHO Group 5)
  • Eisenmenger syndrome
  • Complex or unrepaired congenital heart disease

• Suspected pulmonary veno-occlusive disease (PVOD)

• Pulmonary capillary haemangiomatosis (PCH)

• Acute decompensated right heart failure

• Severe renal dysfunction (eGFR <30 mL/min/1.73 m²)

• Severe hepatic impairment (Child-Pugh Class C)

• Congestive hepatopathy

• Active infection

• Pregnancy

• Inability or unwillingness to provide informed consent

• Poor ultrasonographic acoustic window preventing adequate VExUS scoring

Trial design

86 participants in 1 patient group

PAH Cohort

Description:

Adults with World Health Organization (WHO) Group 1 pulmonary arterial hypertension undergoing non-invasive assessment with the Venous Excess Ultrasound Score (VEXUS) and the ESC/ERS 2022 simplified four-strata risk model during routine clinical follow-up. No intervention is administered; this is an observational cohort with a single study visit in which VEXUS, 6MWT, BNP, WHO-FC and recent haemodynamic parameters are collected.