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10.3390/jcm15031111
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Assessing Venous Congestion in Heart Failure: A Review of Splanchnic, Cardiac, and Pulmonary Ultrasound: Part 2: Contrast-Enhanced Ultrasound and Shear Wave

by
Francesco Giangregorio
1,*,
Esther Centenara
1,
Samanta Mazzocchi
1,
Luigi Gerra
2,
Francesco Tursi
3,
Davide Imberti
4 and
Daniela Aschieri
2
1
Department of Internal Medicine, Castel San Giovanni Hospital, Vle II Giugno, 1, 29015 Castel San Giovanni, Italy
2
Department of Cardiology, Piacenza Hospital, Via Taverna 49, 29121 Piacenza, Italy
3
Cardiac and Pneumological Rehabilitation Medicine, Codogno Hospital, 26845 Lodi, Italy
4
Department of Internal Medicine, Piacenza Hospital, Via Taverna 49, 29121 Piacenza, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(3), 1111; https://doi.org/10.3390/jcm15031111
Submission received: 19 December 2025 / Revised: 13 January 2026 / Accepted: 23 January 2026 / Published: 30 January 2026
(This article belongs to the Section Nuclear Medicine & Radiology)
Versions Notes

Abstract

Background: Heart failure (HF) is a systemic syndrome characterized by venous congestion, which critically involves the splanchnic circulation. Conventional assessment methods often lack sensitivity for early or regional congestion. Methods: We conducted a systematic review of studies utilizing contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) to evaluate congestion in adult HF patients, synthesizing evidence up to July 2025. Results: The integrated evidence demonstrates that CEUS and SWE provide distinct, complementary quantitative data. CEUS acts as a functional pillar, detecting microvascular congestion through parameters like prolonged hepatic vein transit time. SWE serves as a structural pillar, quantifying tissue stiffness that correlates with central venous pressure, tracks decongestion, and independently predicts adverse outcomes. Together, they differentiate reversible hemodynamic congestion from irreversible fibrotic remodeling across the liver, spleen, kidneys, and heart. Conclusions: Integrating CEUS and SWE into a multi-parametric ultrasound framework provides a comprehensive, bedside assessment of systemic congestion in HF. This approach enhances early detection, improves risk stratification, and offers a potential tool for guiding and monitoring personalized decongestive therapy, representing a significant advancement in holistic HF management.
Keywords: heart failure; congestion; splanchnic circulation; contrast-enhanced ultrasound (CEUS); contrast-enhanced echocardiography; shear wave elastography (SWE); portal vein; hepatic vein; liver stiffness; microbubbles; cardiorenal syndrome; venous excess ultrasound (VExUS) heart failure; congestion; splanchnic circulation; contrast-enhanced ultrasound (CEUS); contrast-enhanced echocardiography; shear wave elastography (SWE); portal vein; hepatic vein; liver stiffness; microbubbles; cardiorenal syndrome; venous excess ultrasound (VExUS)

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MDPI and ACS Style

Giangregorio, F.; Centenara, E.; Mazzocchi, S.; Gerra, L.; Tursi, F.; Imberti, D.; Aschieri, D. Assessing Venous Congestion in Heart Failure: A Review of Splanchnic, Cardiac, and Pulmonary Ultrasound: Part 2: Contrast-Enhanced Ultrasound and Shear Wave. J. Clin. Med. 2026, 15, 1111. https://doi.org/10.3390/jcm15031111

AMA Style

Giangregorio F, Centenara E, Mazzocchi S, Gerra L, Tursi F, Imberti D, Aschieri D. Assessing Venous Congestion in Heart Failure: A Review of Splanchnic, Cardiac, and Pulmonary Ultrasound: Part 2: Contrast-Enhanced Ultrasound and Shear Wave. Journal of Clinical Medicine. 2026; 15(3):1111. https://doi.org/10.3390/jcm15031111

Chicago/Turabian Style

Giangregorio, Francesco, Esther Centenara, Samanta Mazzocchi, Luigi Gerra, Francesco Tursi, Davide Imberti, and Daniela Aschieri. 2026. "Assessing Venous Congestion in Heart Failure: A Review of Splanchnic, Cardiac, and Pulmonary Ultrasound: Part 2: Contrast-Enhanced Ultrasound and Shear Wave" Journal of Clinical Medicine 15, no. 3: 1111. https://doi.org/10.3390/jcm15031111

APA Style

Giangregorio, F., Centenara, E., Mazzocchi, S., Gerra, L., Tursi, F., Imberti, D., & Aschieri, D. (2026). Assessing Venous Congestion in Heart Failure: A Review of Splanchnic, Cardiac, and Pulmonary Ultrasound: Part 2: Contrast-Enhanced Ultrasound and Shear Wave. Journal of Clinical Medicine, 15(3), 1111. https://doi.org/10.3390/jcm15031111

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