A study to assess the role of vericiguat in the cardio-pulmonary pathophysiology in worsening heart failure with reduced ejection fraction (REVOLUT- HFrEF)
A D'amato, C S Camilla Segato, S P Silvia Prosperi, R G Rosanna Germano, V M Vincenzo Myftari, S M I Stefanie Marek Iannucci, C C Claudia Cestie, F F Federico Ferranti, D F Domenico Filomena, G M Giovanna Manzi, S M Serena Marcon, V M Viviana Maestrini, R B Roberto Badagliacca, C D V Carmine Dario Vizza, P S Paolo SeverinoAbstract
Background
Vericiguat reduces major adverse events in patients with heart failure with reduced ejection fraction (HFrEF) and recent worsening. However, its effects on cardiac function and cardio-pulmonary coupling remain insufficiently characterized.
Methods
In this observational, prospective, single-centre study, we enrolled consecutive patients with HFrEF and a recent worsening episode despite GDMT. We performed a comprehensive clinical, biomarkers, and echocardiographic evaluation at baseline (T0) and at 12-month follow-up (T1). The primary endpoint of the study was to assess the impact of Vericiguat on the variation of TAPSE/sPAP ratio and quantitative LVEF from T0 to T1.
Results
We enrolled 60 HFrEF patients with a recent worsening episode. Mean age was 72.5±10.6 years; mean LVEF was 32% (±8). At 12 months, significant improvements in LVEF (p<0.001), LVEDV (p=0.001), LVESV (p<0.001), TAPSE (p=0.01), TTG (p<0.001), sPAP (p<0.001), TAPSE/sPAP ratio (p<0.001), NT-proBNP (p<0.001) and NYHA class (p=0.02) have been observed. A significant reduction in eGFR (p=0.006) and mean haemoglobin (p=0.005) has been also observed (Figure 1). A clear inverse association has been observed between sPAP and TAPSE/sPAP variation (r=-0.697; p<0.001) (Figure 2). At multivariate analysis, Vericiguat therapy was independently associated with improvement in both TAPSE/sPAP ratio (β=0.137; 95%CI 0.072–0.202; p=0.001) and LVEF (β=4.55; 95%CI 2.95–6.15; p=0.001).
Conclusions
In a real-world cohort of worsening HFrEF patients, Vericiguat therapy was independently associated with improvement in both TAPSE/sPAP ration and LVEF, supporting potential hemodynamic and cardiopulmonary benefits leading to the well-known outcome reduction.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.